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STEP-HBTI, KANPUR

SCIENCE & TECHNOLOGY ENTREPRENEURS’ PARK


HARCOURT BUTLER TECHNOLOGICAL INSTITUTE
NAWAB GANJ, KANPUR-208002

PRELIMINARY REGISTRATION FOR ADMISSION IN PGDM COURSE

Name in full:.................................................................................
Father’s Name: ............................................................................
Contact Address: .........................................................................
…………………………………………………………………………………………………….........
Paste
……………………………………………………………………………………………………………. Photograph
……………………………………………………………………………………………………………..
Mobile: ..................................... Date of Birth: .............................
E-Mail:......................................................................................
Percentile Score: CAT- ............................ MAT- ....................... CMAT-…………………………..

Month & Year: CAT- ............................ MAT- .......................... CMAT-…………………………..

Category: SC/ST  OBC  General  NRI 

Work Experience: (In chronological order beginning with the most recent one and going back
words)

Date Organization Designation Responsibility


From To

Academic Background: (Attach photocopies and produce originals for verification)

Examination Year Subjects % of marks Name of Board/


University

High school

Intermediate

Graduation
I hereby declare that the above informations are true to the best of my knowledge and belief. I
agree to abide by the decisions, rules & regulations of STEP-HBTI, Kanpur.

Date :
Place : Signature

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