APPLICATION FORM
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COLLEGE
*
INDIRA GANDHI POLYTECHNIC COLLEGE
WHETHER APPLYING FOR LATERAL ENTRY
*
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YES
NO
REFFERED BY
QUOTA
*
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MANAGEMENT
MERIT
NRI
COURSE APPLIED
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DIPLOMA
BRANCH APPLIED
( PRIORITY 1 )
*
BRANCH APPLIED
( PRIORITY 2 )
BRANCH APPLIED
( PRIORITY 3 )
APPLICANT'S NAME
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DOB
*
GENDER
*
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MALE
FEMALE
TRANSGENDER
BLOOD GROUP
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A+
A-
A1-
AB+
AB-
B+
B-
O+
O-
NATIONALITY
RELIGION
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CHRISTIAN
HINDU
MUSLIM
NOT APPLICABLE
OTHER
CATEGORY/COMMUNITY
RESERVATION APPICABLE
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NO
YES
MOBILE
*
WHATSAPP NO
LAND PHONE NO
EMAIL ID
COMMUNICATION ADDRESS
*
PINCODE
*
PERMANENT ADDRESS
PINCODE
PROPOSED RESIDENCE AFTER ADMISSION
IF NEEDED PLEASE TICK
HOSTEL
COLLEGE BUS
FATHER
CONTACT NO
FATHER OCCUPATION
FATHER QUALIFICATION
MOTHER
CONTACT NO
MOTHER OCCUPATION
MOTHER QUALIFICATION
ANNUAL FAMILY INCOME ( Rs. )
LOCAL GUARDIAN
CONTACT NO
GUARDIAN RELATIONSHIP
WHETHER PHYSICALLY HANDICAPPED
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YES
NO
DESCRIPTION ( IF YES )
WHETHER DEPENDENT OF EX-SEVICE MAN
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YES
NO
DESCRIPTION ( IF YES )
WHETHER MEMBER OF NSS / NCC
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YES
NO
DESCRIPTION ( IF YES )
REMARKS ( IF ANY )
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EDUCATIONAL DETAILS
SSLC
SCHOOL / INSTITUTION
BOARD / UNIVERSITY
REGISTER NO
MONTH OF PASSING
YEAR OF PASSING
MARKS (%)
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JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPEMBER
OCTOBER
NOVEMBER
DECEMBER
PLUS TWO / ITI
( IF QUALIFIED PLESAE CHOOSE YES )
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YES
NO
APPLICATION FEE DETAILS
NB : IF YOU HAVE PAID APPLICATION FEES ONLINE PLEASE PROVIDE THE DETAILS.
TRANSACTION ID / RECEIPT NO
DATE
AMOUNT
DECLARATION
I do here by declare that I am an INDIAN citizen and all information furnished above are true and I will obey rules and regulations of the institution, if I am admitted. I shall submit all certificates and documents in original at the time of admission, failure of which my admission will be liable to cancellation.
I Agree
NB : Fees once paid shall not be refunded under any circumstances.
APPLICATION FORM
Reffered By
LATERAL ENTRY
Quota
Degree Applied
Course Applied
Priority 1
Course Applied
Priority 2
Course Applied
Priority 3
PERSONAL DETAILS
Name
DOB
Gender
Blood Group
Nationality
Religion
Category
Reservation
Mobile
WhatsApp No
Land Phone No
E Mail ID
Communication Address
Permanent Address
Proposed Residence
Hostel
Bus
Father
Contat No
Father Qualification
Father Occupation
Mother
Contat No
Mother Qualification
Mother Occupation
Annual Income
Local Gaurdian
Contact No
Relationship
Physically Handicapped
Ex-Service man
NSS / NCC
Notes
Image
Signature
APPLICATION FEE DETAILS
Transaction ID / Receipt No
Transaction Date
Amount
EDUCATIONAL DETAILS
SSLC
School/Institution
Board
Reg No
Pass Month / Year
Mark
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APPLICATION SUBMITTED
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