Scribd
Upload
21 views4 pages

Applicarion For Admission

Diploma admission

Uploaded by

khanish063
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
21 views4 pages

Applicarion For Admission

Diploma admission

Uploaded by

khanish063
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
You are on page 1/ 4

ADIT YA ENGINEERING

An AUTONOMOUS Institution
COLLEGE
Approved by AICTE & Permanently Affiliated to JNTUK, Accredited by NBA & NAAC with ‘A’ Grade
Recognized by UGC under sections 2(f) and 12(B) of the UGC Act 1956
ADITYA NAGAR, ADB ROAD, SURAMPALEM - 533 437, E.G. DIST., A.P.

APPLICATION FOR ADMISSION


Regd. No.
Passport Size
Admin. No : Date: D D M M Y Y Y Y Photograph
Admitted Category : CQ MQ Spot FN LE (Colour)

Course :................ .Branch :.

Cet Rank :............. H.T. No.:

I. PROFILE (As per X Class)


1. Name :

2. Date of birth : D D M M Y Y Y Y
3. Gender : Male Female
4. Student E-mail ID :
5. Father’s Name :

a) Occupation :
b) Father E-mail ID :
c) Mobile No. :
6. Mother’s Name :
Mobile Number :
7. Address for correspondance :
a) House No. / D.No. :
b) Street :
c) Location :
d) City / Town / Village :
e) PIN / ZIP Code :
f) Mandal / Tasil :
f) District :
g) State :
h) Country :
8. Religion :
9. a) Caste : OC BC - A B C D E SC ST
b) Sub Caste Name :
10. Whether Physically Handicapped : YES NO
11. Mother Tongue :
12. Aadhar Card No. :
II LOCAL GUARDIAN
a) Name of the Guardian :
b) Occupation :
c) Mobile No. :
d) Student Relationship with Guardian :
e) E-mail ID :

IV PREVIOUS ACADEMIC DETAILS


a) Academic :

School / College State / Year of Marks / Total Class /


Course Medium Board GPA Marks / Pass %
Country Passing Obtained CGPA Divin.

SSC / 10th

INTER / +2

DIPLOMA

DEGREE
( )

Intermediate Mathematics: Physics: Chemistry:


Group Marks: Marks Obtained in Group : Total Group Marks :
b) Student ID Marks as per SSC 1) :
2) :
V HEALTH RECORD
a) Blood Group : A B AB O +ve -ve

b) Other medical problems :

SELF DECLARATION :
I hereby declare that the partiulars furnished are true to the best of my knowledge and i did to
not suppress any relevant information. I am aware that my admission is liable for cancellation, if, at
a later stage, it is established that I suppressed any relevant information. i further declare that I am
aware of the University rule that a minimum attendance of 75% is required to appear for semisterend
Examinations and i will abide by the above University rule and all ruled and regulations stipulated
by the Institute from time to time.

Signature of the Student


SELF DECLARATION :
I hereby undertake that if my ward is admitted, I will ensure that he / she will observe all
rules and regulations of the institute and, will pursue his / her studies regularly and with all
seriouness. I further undertake that I will pay all the prescribe fees well in time and I will
financially support my ward during his / her years of study at the Institute

Signature of the Parent

UNDERTAKING BY THE STUDENT AND PARENT / GUARDIAN


I, .......................................................................................................... studying
........... (year) B.Tech. / M.Tech. / MBA / MCA ............................................... Branch,
Son / Daughter of ..................................................................................................
Ph: ....................................
Undertake that I am aware of the meaning of ‘Ragging’ as defined by supreme Court,
that “Ragging is any disorderly conduct, whether by words spoken or written, or by an act
which has the effect of teasing, treating or handling a fresher or a junior with rudeness any
student, indulging in rowdy or indisciplined activities which cause or are likely to cause
annoyance, hardship or psychological harm or to raise fear or apprehension thereof in a
fresher or a junior student and which has the effect of causing or generating a sense of shame
or embarrassment so as to adversely affect the psyche of a fresher or a junior student”.
I am also aware of the system of punishment in case of ragging other students and that in
case I become involved in the act of ragging I am liable for any punishment including :
1. Cancellation of admission.
2. Suspension from attending classes.
3. Withholding / withdrawing scholarship / fellowship and other benefits.
4. Debarring from appearing for any test / examination or other evaluation process.
5. Withholding results.
6. Debarring from representing the Institution in any National or International Meet,
Tournament, Youth Festival etc.
7. Suspension, expulsion from the hostel.
8. Rustication from the Institution for periods varying from 1 to 2 academic years.
9. Expulsion from the institution and consequent debarring from admission to any other institution.
10. Fine up to Rs. 50,000/-
11. Rigorous imprisonment up to three years (by court of Law) etc.,
I endorse the under taking given above and I abide by the same.

Parent / Guardian Signature of the Student


Station :
Date :
SWORN AFFIDAVIT
I ............................................................. S/o, D/o. ...................................................
aged .................. years, residing at ...................................................................................
......................................................................................................................... do hereby
solemnly and sincerely affirm and state as follow:
I have been admitted in the Course of .................... Department (Branch) of ..................
Aditya Engineering College , Surampalem.
I understand that once a seat is allotted by the Convener/Management/Spot Admission/
Foreign Nationals and if I withdraw from the college or opts for leaving the college for any
reason whatsoever once the admission formalities are completed and closed the seat has to be
kept vacant throughout the subsequent years also as per AICTE and APSCHE (Govt. of AP)
directives. I very much appreciate that if that sort of situation arises because of me the college
will be sustaining financial loss to the extent of the Tuition fee payable for remaining pursued
years of study. Hence I hereby expressly agree to affirm that the tuition fees and other charges
will be paid by me in the eventuality of my discontinuation of studies for whatever reason and
only then I shall seek for return of my original certificates.
I am giving this undertaking / affidavit of my free will and volition voluntarily and under
no coercion, or duress, as I very much appreciate the position of the College.

Deponent
I understand fully well all the above affidavit statement that my ward has given above
and I also hereby state that I will abide by each and every statement given in this affidavit by
my ward.
Parent
CHECK LIST
Please () mark in the relevant box
Original Xerox Original Xerox
1) Allotment Order : 12) Transfer Certificate :
2) Joining Report : 13) Study Certificates :
3) Fee Receipt : (Inter, Degree, PG)
4) Hall - Ticket : 14) Passport Size Photos :
5) Rank Card : 15) Aadhar Card :
6) SSC/X Class (CBSE/ICSE & : 16) Migration Certificate :
Other Board) MM & Pass Certificate 17) Citizenship Card :
7) Inter/XII Class (CBSE/ICSE& : 18) Passport :
Other Board) MM & Pass Certificate 19) Medical Certificate :
8) Bridge Course MM : 20) NOC from Embassy :
9) Diploma (MM / CMM & P.C.): 21) Blood Group Certificate :
10) Degree (P.C. / OD) :
11) Degree (MM / CMM) :
For office use only
Remarks :

Date : Signature of the A.O.

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy