Application Form

NOTE:

On the below of form following information needs to be added Information for filling up the applications
1. Your name should match the name in your class X certificate/Marksheet.
2. Please keep your std X, XII and engineering/ technology marksheets ready for reference to fill up application
3. Before submitting the form, verify that all details are filled up correctly.
4. After submitting the application, you will be directed to “Payments” for paying Rs. 2500/- (Rupees two thousand five hundred) only for application fees.

Full Name*
(As appearing in X certificate / mark list)

Gender*

Male Female

Date of Birth*

Father's/ Guardian's Name*

ADDRESS FOR COMMUNICATION

Address for Communication (Please write same as above if address For communication is same as Permanent Address)

City

Pin Code

Email Id*

Mobile Number*

Permanent Address

Permanent Address*

City*

State*

Pin Code*

Email Id*

Academic Details

Graduation*

B.Tech B.E

Specialisation*

Year of Passing*

Percentage of marks*

University

College

City

Board

CBSE ISCE State

Year of Passing

Percentage of marks

School

City

Board

CBSE ISCE State

Year of Passing

Percentage of marks

School

City

How did you come to know about IMRT Programs*