APPLICATION FOR ADMISSION TO DIPLOMA COURSES
Dr.B.R.AMBEDKAR POLYTECHNIC COLLEGE FOR THE ACADEMIC YEAR 2020-2021
Email address *
1. NAME OF THE COURSE FOR WHICH APPLICATION IS MADE *
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2. a) NAME OF THE COURSE FOR WHICH APPLICATION IS MADE (PLEASE SELECT THE COURSE FOR WHICH APPLICATION IS MADE) - COURSE PREFERENCE -1 *
2. b) COURSE PREFERENCE -2
2. c)COURSE PREFERENCE -3
3. NAME OF THE CANDIDATE (IN CAPITAL LETTERS) *
4. FATHER’S NAME / MOTHER’S NAME/GUARDIAN’S NAME(ONLY IF PARENT ARE NOT ALIVE) *
5. DATE OF BIRTH (AS PER SSLC OR EQUIVALENT EXAMINATION) *
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DD
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YYYY
6. PERMANENT ADDRESS *
7. ADDRESS TO WHICH COMMUNICATION IS TO BE SENT *
8. MOBILE NO *
9. SEX *
10. E-MAIL ADDRESS *
11.a. AADHAR CARD NO *
12. COMMUNITY(ENCLOSE SELF ATTESTED COPY) *
13. NATIONALITY(ENCLOSE SELF ATTESTED COPY) *
14. RELIGION *
15. HAVE YOU SERVED IN N.C.C. FOR MORE THAN 2 YEARS WITH MORE THAN 75% ATTENDANCE? (IF YES , ENCLOSE SELF ATTESTED COPY OF DISCHARGE CERTIFICATE) *
16. MENTION SPECIAL QUOTA, FOR WHICH CLAIM IS MADE *
17. MENTION REGION TO WHICH SPECIAL ALLOCATION IS CLAIMED *
18. a. NAME OF THE QUALIFYING EXAMINATION *
18. b.MONTH AND YEAR OF PASSING *
MM
/
DD
/
YYYY
18. c.NUMBER OF ATTEMPTS
18. d.TOTAL MARKS OBTAINED
18. e.TOTAL MAXIMUM MARKS
I hereby declare that the information given above and in the enclosed document are true to the best of my knowledge and belief and nothing has been concealed therein. I am well aware of the fact that, if the information given by me is proved false / not true, I shall be liable for punishment as per the law. Also, all the benefits availed by me shall be summarily withdrawn. *
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A copy of your responses will be emailed to the address you provided.
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