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Online Registration Form - 2012 (Lateral Entry)
1. FullName *
 :
2. Date of birth * :
Date Month Year
3. Gender *   :      
4. Religion * :  
5. Community * :
6. Mother Tongue * :  
7. Address for Correspondence * :
City * :
Country * :  
Postal Code * :  
Phone No. with Country Code
Mobile No. * :
Phone No. :
Email ID * :
Confirm Email ID * :  
8. Name of the Parent/Gaurdian * :
9. Parent's/Gaurdian's Occupation * :
Qualifying Examination Details
10. 10th % with name of the School * :
%  
Percentage School Name
11. 12th % with name of the School (if applicable) :
%  
Percentage School Name
12. Qualifying Examination (Polytechnic) * :
13. Reg Number in Polytechnic. * :
14. Name & address of the Polytechnic last studied * :
15. Department * :
16. Month and Year of passing/appearing * :
17. Marks Obtained (in %) :
III Semester % *     IV Semester % *    
V Semester % *     VI Semester % 
18. Medium of Instruction * :
19. XII Board * :