Application for Admission to the Engineering College Hostel

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Please Fill all fields .

Admission No *

Exam Register No /Entrance rank for first years/Final Sem.Diploma Reg.No. for LET candidates*

Name *

Gender *

Branch & Semester *

Category *

Religion & Caste *

CGPA/Rank (For first year PG ,CGPA in UG can be taken )[Verified by Tutor] *

Date of Birth *


Mobile *

Email *

Address *

Pincode *

Distance (KM)*


Parent's Name *

Parent's Phone No. *

e-mail (if any)

Parent Address (200 characters)


Local Guardian * (If not avilable ,Enter staff tutor name )

Local Guardian Contacnt No* (If number is not available enter any Number )

e-mail (if any)

Gaurdian's Address (200 characters)

Where stayed during last 2 year *

No of years stayed in hostel * ( Input the value 0 or higher ,If not stayed in hostel please fill 0 )

Room No. (only for hostel inmates)

Whether cleared all dues*