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COUNSELLING STARTED AT , CYBER WORLD , JANTA BHAWAN ROAD, SIRSA.

PH:9812453153, 9416150676

Haryana State Counseling Society


B.TECH-2011
(Information to be filled in by the Candidate for online counseling) Roll No. Name (as per B.TECH admit card) Form no. Date of birth (as admit card) Fathers Name Physically Handicap Category Sub Category ESM Category Name of School Type of School Location of School Qualification Address : : : : : : : Govt./Aided/Private/Open Rural/Urban 10+2 %age PCM% Contact no / Mobile no. Filling of Choices Sr. No. Name of Institute Branch / Trade : : : : : : : (DD/MM/YYYY) Yes / No

Government of Haryana

Note : if you want to add more then use backside of this paper. Signature Of Candidate

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