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Approved by AICTE, New Delhi. Affiliated to Anna University, Chennai
Application Form For Admission To BE/BTech Degree Programmes By Lateral Entry 2011
1. FullName
*
:
2. Date of birth
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:
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
...
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
...
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
Date
Month
Year
3. Gender
*
:
Male
Female
4. Religion
*
:
...
Hindu
Christian
Muslim
Others
5. Community
*
:
...
OC
BC
MBC
SC
ST
6. Mother Tongue
*
:
7. Address for Correspondance
*
:
City
*
:
State
*
:
(Mention only state)
Country
*
:
Postal Code
*
:
Phone No. with Country Code
Mobile No.
*
:
Phone No.
:
Email ID
*
:
Confirm Email ID
*
:
8. Name of the Parent/Gaurdian
*
:
9. Parent's/Gaurdian's Occupation
*
:
Qualifying Examination Details
10. 10
th
% with name of the School
*
:
Percentage
School Name
11. Qualifying Examination (Polytechnic)
*
:
...
Appearing
Appeared
12. Reg Number in Polytechnic.
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:
13. Name & address of the Polytechnic last studied
*
:
14. Department
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:
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Aeronautical
Civil
CSE
ECE
EEE
EIE
ICE
IT
Marine
Mech
Production
15. Month and Year of passing/appearing
*
:
...
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
...
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
16. Marks Obtained (in %)
*
:
III Semester
IV Semester
V Semester
VI Semester
17. Medium of Instruction
*
:
...
English
Tamil
Hindi
Others
18. XII Board
*
:
...
Not Applicable
State Board
Central Board
Intermediate
Others
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