NATIONAL INSTITUTE OF TECHNOLOGY

ROURKELA 769 008

PHOTOGRAPH

RESUME SHEET
1.

Full Name:

2.

Fathers Name:

3.

Mothers Name:

4.

Department:

5.

Degree pursuing:

[FIRST]

[MIDDLE]

[LAST]

Roll No.:

Blood Group:
B Tech

M Tech (Res)

MBA

M Tech

M Sc (2 Years)

MA

M Tech (DD)

M Sc (Integrated)

Specialization:
6.

Address @ NITR:
E-Mail:

7.

Mobile No.

Permanent Home Address:

VILL/@:
P.S.:
STATE:
TEL No.:
(STD Code)

POST:
DIST.:
PIN:
MOBILE No.:

(Number)

8.

Date of Birth:

9.

Nationality:

Height:

10.

Category:

11.

JEE Mains Rank (for B Tech students

only):

12.

Mode of Admission

13.

Academic Background (High School onwards):

Examination
Year CPI or %age
Institution
10th
12th
B Tech*
B Sc / B A*
(*For M Tech / M Sc / M A Students only)

14.

Permanent Account Number (PAN):

15.

Passport Details:
Passport No.

SC*

ST*

________________

Sex:

Male

Female

Weight:

OBC*

[*Copy of proof must be attached]

GENERAL

GATE/JAM Rank (for M Tech/M Sc students only):

Valid up to:

Board / University

____________

Place of Issue:

Subjects taken

______________
PTO

:: 2 ::
16.

SGPA & CGPA (Attach a copy of your latest Grade Sheet):

I
II
III
IV
SGP

17.

CGP

SGP

CGP

SGP

CGP

SGP

CGP

SGP

CGP

SGP

VI

CGP

SGP

VII

CGP

VIII

SGP

CGP

List of Professional Courses taken beyond present curriculum:

(i)

(ii)

(iii)

(iv)

18. Details of Project Work / Summer Training etc.:

19. Scholastic Achievements:

20. Extra-curricular Activities:

21. Do you have any medical disability; including problems like eyesight, color blind, asthma etc.? If yes,
please mention in details.

22. Have you been in an ISDC hearing or faced disciplinary punishment of any kind? If any , mention them.

The information given above is true to the best of my knowledge.

________________
Date

__________________________________
Signature of the Student