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Registration Form 11

This document contains a registration form for submission to JNTUK. It requests information such as the student's name, father's name, mobile numbers, address, date of birth, identification marks, academic records including marks obtained in 10th class and intermediate, and backlogs if the student is in the 2nd, 3rd or 4th year of their B.Tech program. Fields like caste, religion, whether the student is a hostler or day scholar, and use of college transport are also included. The student is asked to sign and date the completed form.

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Krishna Prasad Battula
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89 views2 pages

Registration Form 11

This document contains a registration form for submission to JNTUK. It requests information such as the student's name, father's name, mobile numbers, address, date of birth, identification marks, academic records including marks obtained in 10th class and intermediate, and backlogs if the student is in the 2nd, 3rd or 4th year of their B.Tech program. Fields like caste, religion, whether the student is a hostler or day scholar, and use of college transport are also included. The student is asked to sign and date the completed form.

Uploaded by

Krishna Prasad Battula
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REGISTRATION FORM

INFORMATION FOR SUBMISSION TO JNTUK


Year of Admission: Roll No: 15339-M-036 CIVIL EEE ME ECE CSE
Branch:

1. Name of the student: M u v v a l a V e n k a n n a N a n a j i


IN BLOCK LETTERS:

2. Fathers Name: 9 R a m a n a

3. Mobile no of student: 9 6 6 6 1 3 8 8 3 8

4.Mobile OR Contact No of Ph.no-1 9 6 6 6 1 3 8 8 3 8


Father/Mother/Guardian : 8Ph.no- 9 6 6 6 3 6 8 7 1 9
2
5. Address for Communication:
___________________________________________________
__________________________________________________
5(a). Parents Annual Income: 60000_________________

6. Academic Record Marks %


Marks Obtained in 10th class 570 54
Marks Obtained in Intermediate
Marks Obtained in Diploma for lateral entry student 4900 79

D D M M Y Y Y Y
0 7. Date of Birth : 0 7 0 6 2 0 0 0

8. Moles for Identification: _A mole of the right chest ________________________________________________


As given SSC __________________________________________________

9. Aadhar Card No:

10. Ration Card No:

11. Caste: __________ Sub Caste:_____________ Religion: _______________

12. Are you a Hostler (or) Day Scholar

13. Do you use College Transport: Place of Boarding: ___________________

14. If you are in II year B.Tech:


Have you passed all Subjects in I/1 & I/II % Total
If not what are you back logs in I/1 I/2

Have you passed Have you passed % Total


15. If you are in III year: all Subjects in I/1, I/2, II/1, II/2
Back logs in I/1 I/2 II/1 II/2

Have you passed all subjects in % Total


16. if you are in IV year: I/1, I/2, II/1, II/2, III/1, III/2,
What are back locks in I/1 I/2 II/I II/2 III/1 III/2

Mommidivaram: Signature
Date:
Tick which ever is applicable, Strikeout which ever is not applicable

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