B.B. Road, Chickballapur-562 101, Karnataka State.Phone :08156-263181 / 82 / 83, Fax : 263180, E-Mail: sjcit1@rediffmail.com

URL : www.sjcit1.org / www.sjcit.ac.in

Name of the Applicant (IN BLOCK LETTERS)(as per 10th Marks Card)

1.

2.

3.

4.

6.

App. No.

SJC INSTITUTE OF TECHNOLOGYSJC INSTITUTE OF TECHNOLOGYSJC INSTITUTE OF TECHNOLOGYSJC INSTITUTE OF TECHNOLOGY(Affiliated to Visvesvaraya Technological University (VTU), Belgaum

& Approved by AICTE, New Delhi) (NBA Accredited and ISO 9001:2008 Certified)

APPLICATION FOR ADMISSION TO DEGREE COURSE IN ENGINEERING

Name of the Parent

Father

Mother

A) Permanent Address : (in Block Letters)

Occupation of Parent/Guardian

Annual Income

A) Nationality :

B) Religion : D) Caste Group : (As per Admission) E) Sex :

C) Caste :

5. A) Date of Birth : D) Place of Birth :

B) Age : C) Blood Group : E) Mother Tongue :

C) Phone No. If any

1. 2.

Nearest Police Station :

Railway Station :

(of the Native Place)

B) Present Communication Address :

|| Jai Sri Gurudev ||

Sri Adichunchanagiri Shikshana Trust (R.)FOR OFFICE USE ONLY

GENERAL RULES

USN :

Checked by Registrar Principal

To

The Principal,

S.J.C. INSTITUTE OF TECHNOLOGY

Chickballapur-562 101AFFIX

PASSPORTSIZE PHOTO

HERE

The applicant Mr. / Ms. .............................................................................................................................. has been

given provisional admission to 1st Semester B.E., in ........................................................................................... Branch

for the academic year 20 - 20 .

Fees Rs. ....................................................................................... paid Vide Receipt No. ................................................

Dated ........................................................ Admission No. ................................................

BRANCH :

1. Application is to be submitted to the Principal, S.J.C. Institute of Technology, Chickballapur

along with 3 Passport size and 3 Stamp size Colour Photos.

2. Application with incomplete information is liable to be rejected.

3. Original documents should be submitted at the time of admission along with three sets of

Xerox copies (Attested)

4. Application should be accompanied by proper receipt for having paid the fee.

5. The candidates admitted will have to abide by the rules and regulations prescribed by the

authorities of the college.

6. Those who want hostel facilities shall have to apply after admission to the college. Hostel

facilities are available for both boys and girls.

7. Eligibility Certificate in case of N.R.I. / Foreign candidate is to be submitted at the time of

admission.

8. Institution strictly condemns any kind of direct or indirect involvement pertaining to ragging

and has anti ragging policy.

Dist. :State :Country :

E-mail :

Mobile :

7. 10th Standard Details :

EDUCATION DETAILS(Tick appropriate boxes wherever necessary)

Name of the Institution & Place

Medium of Instruction

Yes NoStudied at District Head Quarters

Month & Year of Passing Month YearMarks Obtained:

PUC / XII Std. Details :

Name of the Institution & Place, last studied

Name of the Board / University

Out of

Out of

Percentage of Marks

Percentage of Marks

8.

9.Optional Subjects Max.

MarksMarks

Obtained

Aggregate% of PCM / PMB

E / CS Marks

Maths

Diploma Holders only

Physics

Diploma Final Year Marks

Total

Chemistry / Biology / Bio Technology /Computer Science / Electronics (Tick any one of the above subjects)

State

Reg. No.Marks

Obtained :

Medium of Instruction at PUC / XII Level

Kan :

Kan :

Eng :

Eng :

Others :

Others :

Optional Subjects

NOTE : English should have been

studied as one of the subjectsPCMB / PCMC / ..............................................................

10. Admission Type :

Original Documents along with three sets of attested copies of the following Certificates to be enclosed( Tick the ones enclosed)

a) Marks Card of qualifying exam (PUC / 10+2 / Equivalent Board)

b) 10th Marks Card

c) Transfer Certificate

d) Caste Certificate (OBC student only)

e) Study Certificate

f) Migration Certificate (Incase of Non-Karnataka/CBSE)

Extracurricular activities

Signature of the Applicant

Signature of the Parent / Guardian

Place :

Date :

Place :

Date :

I, ...................................................................................... S/o / D/o ........................................................................,

the candidate seeking admission to 1st Semester B.E., in S.J.C. Institute of Technology, Chickballapur solemnly

declare that I will strictly abide by the rules and regulations in force or those that may be framed hereafter and

will not indulge in any unsocial & antinational activities. I will not involve in acts of indiscipline and breach

of rules. I will not involve in any form of ragging activity inside or outside the campus. I further agree to make good any

damage to Building, furniture, apparatus etc., which may be due to negligence / carelessness on my part.

The information given above in the application is true and if found false, necessary action may be taken

against me.

I, ............................................................................................................................................................... Parent /

Guardian of the above applicant shall be responsible for the payment of fees, dues, loss or damage, if any.

I shall also be responsible for his / her conduct and good behaviour during the period of his/her studies in this

college.

DECLARATION

DECLARATION

CET COMED-K NRI / MQ

11.

12.

1.

2.

3.

a) CET Order No. / Date

a) COMED-K Order No. / Date

a) AIEEE Order No. / Date

b) CET Rank

b) COMED-K Rank

b) AIEEE Rank

c) CET No.

c) COMED-K No.

d) Allotted Category

d) Allotted Category

c) AIEEE No.

Month & Year of Passing