Estd. 1997 SKIET SKIET f r kZ o H ¼ f l f d e t Z k Shri Krishan Institute of Engineering & Technology And Shri Krishan Polytechnic Estd. 2005 SKP SKP f r kZ o H ¼ f l f d e t Z k Sirsla Road, Ratan Dera, P.O. Pipli, Kurukshetra 136 131 (Haryana) Approved by AICTE, DTE & Affiliatecd to Kurukshetra University Registration/Admission Form (USE CAPITAL LETTERS ONLY) Name: Permanent / Correspondence Address: ....................................................................................................................... City: ........................................................ State:.......................................................... Pin Code .................................... Contact No.(With STD Code):...........................................................Mob: .................................................................. Email ID:............................................................................................................................................................................. Affix Your Recent Passport Size Coloured Photograph Course for which seeking admission (M.Tech - CSE, B.Tech - CSE, IT, ME, CIVIL, ECE), (Management - MBA & BBA), (Diploma- CSE, ME, CIVIL, ECE, EE, AE):- Category (SC/ ST/ OBC / GEN.) : 9. 7. 10. AIEEE/MAT CAT/ GATE / DET / LEET / DET-L (Tick as aplicable) Ö Rank Roll No. Sr. No. _____________ Course ................................................................. Direct/ LEET/DET-L .............................. Branch ........................... 8. Domicile State: 11. (a) Academic Record : Sr. Exam Max. Marks Marks Obtd. University/Board Yr. of Passing Roll No. %age 1 2 3 4 10th 10+2 (PCM Only) Graduation .......................... Others .................................. (b) Gap Years: ................................................................................................... (c) Have you ever been disqualified from studies : YES/NO 1. th Father's Name: ............................................................................................................................. (As given in 10 Certificate) 5. Date of Birth: 3. Sex (Tick Ö): Male Female 4. Nationality:........................ 2. 6. Parent's & Guardian Details Father Mother Occupation Contact Nos. & Email ID 12. Parents Information: th (As given in 10 Certificate)
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Shri Krishan Institute of Engineering & Technology And ... · Shri Krishan Institute of Engineering & Technology And Shri Krishan Polytechnic Estd. 2005 SKP ¼HkZofr lff t Sirsla
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Estd. 1997
SKIETSKIET
frkZoH¼flfdetZ k
Shri Krishan Institute of Engineering & TechnologyAnd
Shri Krishan Polytechnic
Estd. 2005
SKPSKP
frkZoH¼flfdetZ k
Sirsla Road, Ratan Dera, P.O. Pipli, Kurukshetra 136 131 (Haryana) Approved by AICTE, DTE & Affiliatecd to Kurukshetra University
Registration/Admission Form(USE CAPITAL LETTERS ONLY)
(b) Gap Years: ...................................................................................................
(c) Have you ever been disqualified from studies : YES/NO
1.
thFather's Name: ............................................................................................................................. (As given in 10 Certificate)5.
Date of Birth: 3. Sex (Tick Ö): Male Female 4. Nationality:........................2.
6.
Parent's & Guardian Details
Father
Mother
Occupation Contact Nos. & Email ID
12. Parents Information:
th(As given in 10 Certificate)
Place: .....................................
Date: .........../........../...............
...........................................Guardian's Signature(with relation & full Name)
...........................................
Student's Signature
FOR OFFICE USE ONLY
Details of Fee Deposited (Amount) Category : SC/ST/OBC/Gen.
by Draft / Cheque / Cash Receipt No. .................................. Bank .............................................. Date .........................
Registration No. ......................................... Roll No. .................................. Admitted to Course ...................................