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This document contains an application for admission to an engineering college submitted by Sample Candidate. It includes personal details like name, date of birth, contact information, family details, educational qualifications and course details. The applicant is awaiting results for the 3rd year of their diploma course in Electrical and Electronics Engineering and is seeking admission to a day college program in Mangalore.

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Shiva Kumar M B
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33 views2 pages

Dcetsample

This document contains an application for admission to an engineering college submitted by Sample Candidate. It includes personal details like name, date of birth, contact information, family details, educational qualifications and course details. The applicant is awaiting results for the 3rd year of their diploma course in Electrical and Electronics Engineering and is seeking admission to a day college program in Mangalore.

Uploaded by

Shiva Kumar M B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Candidate's Details

Application Number : 119848


1. Name of the Candidate SAMPLE CANDIDATE cadidate's
[As in SSLC or 10th Std Marks Card] * :
2. Name of the Mother *: MEENAKSH
image
3. Name of the Father : MALLESHA
4. Date of Birth [As in SSLC or 10th Std Marks Card] * : 22/02/1998
5. Gender * : Male
6. Contact Mobile Number * : 9898989898
7. E-Mail-Id : sample@gmail. 8. Mother Tongue : KANNADA
com
9. Annual Income of the family from all sources * : 10000 10. Religion * : Hindu
11. Nationality * : Indian
12. Reservation Category *: Category-1 13. Name of th Caste * : BESTAR

12 (a) Income RD Number (RD00-------) 31068000623


12 (b) Caste RD Number starting with (RD0--------) 31068000623
14. Eligibility Clause Code * : a
15. Native state *: KARNATAKA 16. Native District *: DAKSHINA
KANNADA
(MANGALURU)

Course Details
17. Course Type * : Day Engg College
18. Place where you wish to appear for Diploma CET * : MANGALURU
19. Diploma register number * : 103AA13046
20. Diploma Course Holder in : Electrical and Electronics Engineering
20 a. DCET Examination Subject * : EE - ELECTRICAL AND ELECTRONICS

21. Are you appearing for NATA on or before 30-06-2016 : No

Study Information
22. Total number of completed years of study in Karnataka * : 13
23. Have you Studied in Rural Area from 1st standard to 10th standard ? No
24. Have you Studied in Kannada Medium from 1st standard to 10th standard ? No
25. Are you claiming reservation under Article 371 ( j ) Hyderabad-Karnataka ? No
25 (a) 371(J) RD Number starting with (RD0--------)

26. Candidate's Postal Address for Communication


Full Address * : 2/10/35 PARASHURAM NAGARA FALNIR ROAD, KAVOOR, MANGALORE, DAKSHINA
KANNADA(MANGALURU), KARNATAKA - 575015
27. Special Category :

Study Details
28. Do you possess a certificate of Diploma or Equivalent Examination ? * No
29. Are you Awaiting for any Diploma results or Equivalent Examination ? * Yes
30. Name and Place of the Board / University * : BOARD OF TECHNICAL EDUCATION,
BANGALORE
31. Name of the College * : KARNATAKA POLYTECHNIC
32. College Address : KADRI HILLS MANGALORE
33. Is your qualification marks card issued in grade points ? * No
Year Status of Month of Year of Max. Total Marks Percentage
Result Passing Passing Marks Obtained
1 Pass MAY 2014 1750 1430 82.00
2 Pass MAY 2015 1750 1525 87.00
3 Awaiting NOVEMBER 2015 775 656 85.00

Declaration

Printed Date: 24:05:2016 03:40:17


I declare that the information furnished through online is true and correct to the best of my knowledge and belief. I have read the
Instructions carefully hosted on the KEA website "Information Bulletin for Filling up of Online Application". In case any of the
information furnished online by me is found to be false or incorrect, I shall forfeit the claim to be considered or a seat selected
and allotted by KEA. I am liable for civil and criminal action, that the State Government or the KEA may take against me in this
regard.

signature
Signature of the Candidate Left Hand Thumb impression of Date:
the Candidate

Payment Status
Application Number: Name of the Candidate:
Application Fees: Bank Name:
Bank Charges: Bank Ref Number:
Total Amount: Date of Payment:

Note (For Evening Engg College): candidate after obtaining the diploma, must have minimum of Two Years Full Time Work experience in
a registered firm / Company / Industry / Educational and / Government Autonomous Organizations in the relevant field in which admission
is sought by he / she and in which he/she holds a Diploma as on 1st July, 2016, of the year of admission.

Printed Date: 24:05:2016 03:40:17

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