Application Form

1. Name of the candidate (in capital letters) :

2. Father's Name :

3. Mother's Name :

4. Permanant address :

Pincode :

(Check if the Permanant address is same as Address for Communication)
5. Address for Communication :

Pincode

6. Phone Number with STD code :

7. Alternate Phone Number :

8. Gender :

Male Female

9. Date of Birth (As in S.S.L.C Mark List) :

10. Age as on 1st July :

11. Community :

12. Name of Caste :

13. Sl.No of Certificate & Date :

14. Designation of officer issusing the certificate :

15. Community certificate issusing office :

16. Name of the School last studied :

17. Transfer Certificate No & Date :

18. State :

19. No of Attempts :

20. Month and year of Passing :

Marks in 10th Std (State Board/Matric)

Subject	Mark
Tamil
English
Maths
Science
Social Science
Total

Marks in +2

ACADEMIC

Subject	Mark	Month and year of passing
Tamil
English
Maths
Physics
Chemistry
Bio/Comp
Total

VOCATIONAL

Subject	Mark	Month and year of passing
Tamil
English
Physics/Maths
Trade Theory
Trade Practical I
Trade Practical II
Total

I.T.I

Subject	Mark	Max Mark	Month and year of passing
Workshop Calculus
Social Studies
Trade Theory
Trade Practical
Total

21. Nationality :

22. Place of Birth :

village/Town/City

District

State

23. Native District :

24. Name of the Parent/Guardian :

25. Occupation of the Parent/Guardian :

26. Annual Income of the Parent/Guardian :

27. Choice of BRANCH :

28. Reference (if any) :

Declaration

I ............................... (Applicant's Name) S/o .................................., hereby solemnly and sincerely affirm that the statement made and the information furnished by me in the application are true, correct and complete. I further declare that if the information is found false or otherwise incorrect, I will be liable to forfeit my admission or remove from the roll of th Institution at whatever stage of study it may be, besides making me liable for Criminal Prosecution I declare that I will not demand to REFUND the Tuition fees and other fees If i discontinue my studies in the middle of the academic year.

10th Std (S.S.L.C.) or Equivalent exmination Mark list
Transfer certificate
Community certificate

For Further information kindly contact or correspond to :

GURU RAAGAVINDRA
POLYTECHNIC COLLEGE

No,17 Puthu Street, Kondasamutharam,
Gudiyattam - 632 602.VIr.Dt.
Landmark : Near Fire Station, Next to Deepam Glass Centre upstairs.
Phone:04171-244930
Mobile : 9486939376
email Id:raagavindra@gmail.com
Website:www.gururaagavindraedu.in

GURU RAAGAVINDRA POLYTECHNIC COLLEGE

VEPPOR VILLAGE -635 803 . GUDIYATTAM. R.S

Application for Admission in Diploma Course.

Marks in 10th Std (State Board/Matric)

Marks in +2

Declaration

For Further information kindly contact or correspond to :

GURU RAAGAVINDRA
POLYTECHNIC COLLEGE

GURU RAAGAVINDRA POLYTECHNIC COLLEGE

VEPPOR VILLAGE -635 803 . GUDIYATTAM. R.S

Application for Admission in Diploma Course.

Marks in 10th Std (State Board/Matric)

Marks in +2

Declaration

For Further information kindly contact or correspond to :

GURU RAAGAVINDRAPOLYTECHNIC COLLEGE

GURU RAAGAVINDRA
POLYTECHNIC COLLEGE