STATE BOARD OF TECHNICAL EDUCATION & TRAINING, A.P., VIJAYAWADA.

APPLICATION FORM FOR POLYCET-2023

(For State of Andhra Pradesh)
A) For Students Appearing SSC Examinations in April-2023
Paste the
SSC Hall Ticket (If available) Passport size
Photograph in this box

Mobile Number
Do not Staple/pin
(OR) Photograph and Do
not sign on the
For Students already passed SSC examination ( Upto 2022 batch) Photograph

th
10 Class Hall ticket No
Board
Year of Passing SSC/CBSE/ICSE/NIOS/APOSS

B) Date of Birth

D D M M Y Y Y Y
a. Read the instructions given on the back side of the form.
b. Use Code only for item No.4, 6, 7 & 9 as shown in the back page
AADHAAR Number *

01. Name (In Block Letters as per SSC)

02. Father's Name

03. Date of Birth 04.Sex

05. Address for Correspondence

House No.

Village/Street

Mandal/Town/City

District
PIN

Mobile Number 05(a): Town in which you would like to appear for examination

06. Local/Region 07.Reservation Category

08. Special Category NCC SP PH CAP

09. Minority Community 10.Willing to have assistance in Urdu Medium

11. I declare that I fulfill the eligibility criteria laid down for appearing at POLYCET - 2023 and I shall submit all the original Documents in
proof at the time of admission into Polytechnics for the academic year 2023-24. I also certify that I am Not suffering from any of the
following defects (a) MENTALLY RETARDED (b) BLINDNESS (c) DEAF & DUMB (d) CHRONIC HEART, LUNG, KIDNEY, LIVER DISEASES (e)
MUSCULAR DYSTROPHY. The information furnished above is true to the best of my knowledge and belief. In case any false information
is furnished by me, I shall be made ineligible for admission and I will have noright or claim.
Signature of the Parent/Guardian Signature of the Candidate
 Item No. Item Description Code Expansion
04. Sex M male
F Female
06. Local/Region AU Andhra University Area
OU Osmania University Area
SVU S V University Area
NL Non-Local
07 BCA Back-ward Class-'A' Group
Reservation Category
BCB Back-ward Class-'B' Group
BCC Back-ward Class-'C' Group
BCD Back-ward Class-'D' Group
BCE Back-ward Class-'E' Group
SC Scheduled Caste
ST Scheduled Tribe
EWS Economically Weaker Section
08. Special Category If eligible place a tick mark() in the
respective boxes
09. Minority Community Christian
Muslim
Parsi
Sikh
Buddhist
AngloIndian
AnyOther
10. Willing to have assistance in Y Yes
Urdu Medium N No

Instruction for filing up of Application Form for Computerization purpose

1. Application form should be filled properly and legibly by the student in his/her own
handwriting with ball pen, (blue or black) in CAPITAL LETTERS only.

2. Only good quality Passport size photograph should be pasted. Please do not staple or pin
the photograph. Please do not sign on the photograph.

3. Only codes should be entered in the boxes provided against items 4,6,7,&9 in the
Application Form.

4. Student has to choose the town/city in which he would like to appear for examination.

5. APOSS/NIOS shall cover Mathematics, Science, Social/Computers and should be passed

in all subjects with a minimum of 35% in each subject.

6. Students appearing for SSC examinations in April-2023 should register with Hall Ticket number
(if available)/Mobile Number and for students appeared/passed SSC i.e up to year 2022 batch
should register their SSC hall Ticket Number only
7. Please write the Aadhaar Number in the space provided which is mandatory.

8. OC/BC candidates has to pay the examination fee of Rs. 400/- and for SC/ST candidates Rs. 100/-