ENQUIRY FORM
First Year and Second Year Engineering

Year *	- Select One - First Year Engineering Second Year Engineering
Name of the applicant * (Surname) (First Name) (Middle Name)
Name of the Parent / Guardian
Email *
Address for Correspondence *
PIN Code *
STD Code- Ph.No. *	-
Mobile No. *
Permanent Address *
PIN Code *
STD Code- Ph.No. *	-
Mobile No. *
Date of Birth	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975
Sex	Male Female
Whether belongs to reserve category	Yes No
If yes, state details	- Select One - SC ST VJ DT NT1 NT2 NT3 OBC
Are you physically handicapped? :	Yes No
Is your father am Ex-Serviceman or Defence Service	Yes No
Preference of Course:	I) Computer Engg. Select 1 2 3 4 5 6 7 II) Chemical Engg. Select 1 2 3 4 5 6 7 III) Civil Engg. Select 1 2 3 4 5 6 7 IV) Electronics Engg. Select 1 2 3 4 5 6 7 V) Information Tech. Select 1 2 3 4 5 6 7 VI) Mechanical Engg. Select 1 2 3 4 5 6 7 VII) Bio-Technology Select 1 2 3 4 5 6 7
Have you passed H.S.C. in the first attempt as a regular candidate ?	Yes No
Have you passed H.S.C. with English Subject ?	Yes No
Details of H.S.C. Marks:	Month & Year of Passing Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 Grand Total : Out Of :
Subject Marks Obtained Out Of Physics Chemistry Mathematics PCM Total
Details of S.S.C. Marks:	Month & Year of Passing Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 Grand Total : Out Of :
Details of Diploma Marks:	Month & Year of Passing Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 Grand Total : Out Of :
Verification Code :
	( * ) - Mandatory Fields

I Declare that the information given above is trueto the best of my knowledge. I accept and agree to abide by the rules and regulations issued by TKIET Warananagar now or in future and authorized the Principal to initiate any suitable action, in case, I infringe the rules and regulations of the Institute.