Application for Admission to Colleges

Degree College Details

Zone ______________________________

District ___________________________

Mandal ____________________________ College Name ___________________________

Course ____________________________ Course Combination ______________________

Medium ___________________________ Second Language _______________________

Student Personal Details

First Name ----------------------------------------- Middle Name ------------------------------------------------

Last Name __________________________ Gender _________________________________

Father First Name ________________________ Father Middle name ___________________

Father Last Name ________________________ Mother First Name ____________________

Mother Middle Name _____________________ Mother Last name ______________________

Date of Birth _________________________ Age ___________________________________

Identification Marks 1 ___________________________________________________________

Identification Marks 2 ___________________________________________________________

PHC (%) __________________________ VCH (%) ___________________________________

Nationality ________________________ Religion ___________________________________

Caste _________________________ Aadhar/Voter Card Id ________________________

Mother Tongue __________________________ Marital Status _________________________

Email Id _____________________________________________Mobile No_________________

Father Education ____________________________ Fathers Annual Income________________

Intermediate Details

Group _______________________________ Medium _________________________________

Maximum Marks __________________________ Marks Secured ________________________

Percentage _________________________ Grade __________________________

One attempt ________________________ Compartment ___________________

Year Of Passing _____________________ Name of Jr.College __________________________

Place of Jr.College ___________________________________ District ____________________

Period of Study From________________________ To _________________

Previous Institutes in which Student has studied

Class Name of The School Place of the School Year of Study

Address for correspondence

H.No ____________________________ Street ______________________________________

Village ____________________________ Mandal ____________________________________

District ____________________________ Pin Code No ________________________________

Land Line No ___________________________ Mobile No ______________________________

Extra Curricular Activity at School and Intermediate

Literacy NSS Games & Sports

NCC A B Ex-ServiceMan___________________

Remarks _____________________________________________________________________