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B. Tech II Year (Lateral Entry)

Session: 2011 - 2012
1. Select the Branch you are applying for (tick the appropriate option)
Mechanical Computer Science

Electronics & Communications Civil

Affix a recent colored passport
size photograph of the
2. Name of the Candidate (as given in mark-sheet of class X) candidate

3. Father’s Name (as given in mark-sheet of class X)

4. Occupation of Father

5. Date of Birth (as given in mark-sheet of class X) 6. Category (SC / ST / OBC / General)

7. Address of the Candidate

8. Contact Details of Candidate 9. E-mail ID of Candidate

10. Educational Qualifications (attach photocopy of all mark-sheets and passing certificates along with this form)
Class Year School / College Board/University Percentage


(Tick the appropriate one)

B. Sc.
B.Tech I Yr.
Diploma in Eng.

To be filled by University (Not to be filled by candidate)

Rank in Merit Score of Interview Admission Status

Permitted Not Permitted


(Signature of Interviewer) (Signature of Admission Coordinator)