GAYATRI VIDYA PARISHAD COLLEGE OF ENGINEERING

AN NBA ACCREDITED INTITUTION, Approved by AICTE and Affiliated to JNTU)

Madhurawada :: Visakhaptnam – 530 041

APPLICATION FORM FOR CATEGORY ‘B’ SEATS

M.Tech Embedded Systems & VLSI Design (to be filled in by the candidate)
Chemical Engineering / Computer Science Engineering / Power System Control & Automation / CAD / CAM / Civil Engineering
(Infrastructure Engg. & Mgt) Information Technology (Software Engineering)

1. Name of the Applicant G.R.KARTHEEK

In Block Letters

2. Father’s / Husband’s Name :G.CHINNAPPA

3. Date of Birth : 29/07/1989

4. Sex : M / F : Male

5. Address for Communication and :

D-no:6/186(2b),Market road
Phone Number Somandepalli(post),Andhra pradesh
Anantapur

6. Mobile No and e-mail Id : 9885196641

techindia_karthik@yahoo.in

7. Category : OC
(OC / BC / SC / ST)

8. Detail of GATE Examination: (If Qualified)

Y e a r o f a p pe a ri ng Hall Ticket No. Rank

9. Details of Examinations passed (SSC onwards):

Course Board/University Specialization Month & Year of Passing % of Marks Class Obtained
Passed
Xth Z.p.h.school,Somandepalli Maths May&2004 80.50 First
XIIth Sri sai junior college,Anantapur M.P.C May&2006 69 First
B.E Thirumalai engg college/ Ece April &2010 70 First
Anna university
 Declaration

I here by declare and affirm that the information furnished above is true and complete in all respects. I am
liable for any disciplinary action, if the information furnished by me is found to be false or incorrect at any
stage. I will abide by the rules and regulations of College.

Signature of the Parent / Guardian Signature of the Applicant

Note:
1. True copies of the certificates should be submitted along with the Application

 B.E/B.Tech Study ,Conduct and Transfer Certificates

 B.E/B.Tech Original Degree
 Intermediate (10+2) Certificate
 SSC Certificate
 Service Certificate (for Sponsored candidates only)
 Caste Certificate (SC/ST candidates only)

2. The Original Certificates should be submitted at the time of Admission