Student Registration Form

Program of Study / Branch: Sem:

Photo
Academic Year:

Date of Registration:

1 Name of the Student (In Capitals)

2 University Registration Number

3 Gender Male / Female

4 Date of birth

5 Category (SC / ST / Others)

6 Mobile Number

E- Mail ID

7 Name of the Mentor and Contact Number Name:

Mobile Number:

8 Lateral Entry (If applicable) Change of Branch Change of College Diploma

9 Results of Previous year of study

(Pass, CGPA)

Attach Grade Card of previous two semester/year

10 Elective Subjects for Current Semester

Elective (If Applicable) – Write based on priority Open Elective (If Applicable)

(i) (i)

(ii) (ii)

(iii)

11 Total Number of backlog Subjects (if any)

12 Previous year fee paid details with Date and attach receipt

13 Day Scholar / Hosteler

14 Annual Fee Paid Details (Current Year)

 (i) Tuition Fee Amount

Transaction Number

Date of Payment

(Attach the Receipt)

(ii) Hostel fees (if applicable)

Transaction Number

Date of Payment

(Attach the Receipt)

15 Address for Communication

Communication Address Permanent Address

16 Name of person and Mobile number to be contacted in case of Name:

Emergency Mobile No :

Email ID:

17 Remarks

Undertaking:I have understood that as per the University norms, I am required to attain 85% attendance and minimum internal marks in each semester. In case if I fail

to comply the norms, I will obey the actions which are taken by the college authorities.

Signature of Student

I have checked the details filled above and found it to be correct.

His / Her attendance will be counted from ………..…………………………….

Signature of Mentor Signature of HOD Signature of Principal