University Placement

College Roll Father's

S.No Registration fees Paid/ Full Name Placed in First Name Last Name Gender
No. Name
No Not Paid
 Telephone Date of
Present Permanent Age(As on
Course Branch E mail Mobile No. No. Birth 1
Address Address 1.7.2010)
(Permanent) (MM/DD/YY)
 Whether
No. of Total No. of
cleared all UG
arrears after arrears in
2 3 4 Overall % papers in UG Degree Specialisati UG %
latest earlier
1st Attempt on
semester semesters
Yes / No
 SSLC Start End date HSC Start HSC End
UG
UG Institute SSLC Board date (Month (Month & SSLC % HSC Board Date (Month date (month HSC %
University
& Year) Year) & year) & year)
 Gap in Reason for
Experience ( Total
Post studies, if gap in Signature
if any) Experience
any studies