Government of Karnataka

Department of Pre-University Education Application No.:

Ull PUC Admission Appticailon Form 20
-20

EMPOWER
PU SCIENCE COIIEGE Affix recent
Pass port size
Sadhankeri Main Road, Dharwad photograph

Call Now : 0836-2955111, 8884925111, 9894935111

Ema il : em powerpucollege@gmail.com website : www.empowerpucollege.com

1. Name of the Student as entered in SSLC marks card

(CAPITAL LETTERS ONLY)

Day Month Year

2. a. Date of Birth
(as per SSLC marks card)

b. Place of Birth

3. a. Gender: 3. b. Caste
3. c. Sub Caste : 3.d. Category
3. e. StudentAadhar Card No. :

Candidate
Address

Mother Mobile No.:

Name of the
Parents
Father Mobile No

Part - I Part - ll

1. English 1. Physics
Language and Combination offered
to study in the PU Course 2 2. Chemistry
3. Mathematics
4
7. Subjects studied Marks obtained Medium
1st Language
Result
2nd Language

3rd Language

Science
Percentage of Marks
Mathematics

Social Science

Total Marks obtained

Name and address of the school/college last studied