Student Information Form
Email *
AKTU Roll No *
Branch *
Student's Name *
Father's Name *
Mother's Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Category *
10th Board *
10th % *
10th Year of Passing *
12th Board
12th %
12th Year of Passing
Diploma Board
Diploma %
Diploma Year of Passing
B.Tech I Semester % *
B.Tech II Semester % *
B.Tech III Semester % *
B.Tech IV Semester % *
B.Tech V Semester % *
B.Tech VI Semester % *
B.Tech Average % *
Backlog History (No of COP) *
Current Status of Backlog (No of COP) *
Address for Correspondence (Current)
Permanent Address *
Mobile No (Personal) *
Mobile No (Alternate) *
A copy of your responses will be emailed to the address you provided.
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