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STUDENT DETAILS (Fill in Capital Letters) Name of the Student Fathers Name Mothers Name Sisters Date of Birth

(as per SSLC Certificate )

Occupation Occupation Bothers Age

Permanent Address

Present Address

Contact No Community 10th Mark Name of the School 12th Mark Name of the School Diploma Mark Name of the College Academic Performance I Semester I Year II Semester III Semester II Year IV Semester V Semester III Year VI Semester V Semester IV Year VI Semester

Management / Counseling Caste Percentage Percentage Percentage Arrear Arrear Arrear Arrear Arrear Arrear Arrear Arrear

Student Signature

Staff Incharge

HOD

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