ADMISSION FORM
This form is to fill the admission form for the Academic year 2019-2020
Name of the Applicant *
Your answer
Father / Guardian Name *
Your answer
Gender *
DOB *
MM
/
DD
/
YYYY
Name of the School *
Your answer
SSLC Total Mark *
Your answer
HSC Mark (Half Yearly Exam)
Your answer
If Lateral Entry Diploma in
Your answer
Name of the Polytechnic College
Your answer
Percentage of Mark Obtained
Your answer
Course *
Mail Id
Your answer
Residential Address *
Your answer
Contact Number *
Your answer
For Further Clarification
Contact: Jeppiaar Institute of Technology
Sunguvarchatram, Kunnam, Sriperumbudur, Chennai - 631604.
Phone No: 044-2715 9000
E Mail - office@jeppiaarinstitute.org Website: www.jeppiaarinstitute.org
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