Registration Fee

General - ` 100/-
100/-
GOVERNMENT OF KARNATAKA
SC/ST/CAT-1 - ` 50/-
50/-
DIRECTORATE OF TECHNICAL EDUCATION
APPLICATION FORM FOR ON-LINE
LINE INTERACTIVE ADMISSION TO DIPLOMA COURSES FOR THE YEAR 2017
20 18

Before filling the application form, Please

1.SSLC or EQUIVALENT REGISTER No.
read the item wise instructions as given in
the brochure

2. Name of the candidate

3. Date of Birth 4.Aadhaar No.

5. Name of the Father

6. Name of the Mother

7. Sex 88. Address

Male Female Name
9. Telephone Number
a) Landline Address

City .
b) Mobile
State ..
c) E-mail
Pin Code

10. Indian Nationality 11.. Mother Tongue 12.. Qualifying Examination

YES NO SSLC CBSE ICSE OTHER

13. Native State Code 14.. Native District Code

15.. Code of the State Appeared for SSLC / Equivalent 116.. Code of the District Appeared for SSLC / Equivalent

17. Year of 18.. Total Max 19. Total Marks 20.

20 Percentage
Passing Marks in all Sub Obtained in all Sub
21. Marks in 22.Marks in 23.Total Max Marks in 24.Marks
.Marks Obtained
Maths Science Science & Maths Science & Maths
25. No.of Years Studied 26.. Claiming Exemption From Yes No 27.. If YES Mention Clause Code
In Karnataka 5 Years Study Rule
28. Have you Rural Study yes No 29.SNQ Claiming yes No 30.. Have you Kannada yes No
(1st to 10th) Medium (1st to 10th)
31.Income 32.. Category 33. Name of the Caste
34. Special Category Code
NCC JTS JOC HK EDP DP ITI Trade 36. AMOUNT PAID
GK PS SP SS PH AI CI 37. CHALLAN NO
35. 371(J) Hyderbad-Karnataka
Karnataka Claiming Yes NO 38. AMOUNT PAID DATE

DECLARATION 39. RECENT PASPORT SIZE COLOR

We declare that the above information is true and correct to the best of our knowledge PHOTO

Signature of Parent/Guardian Signature of the Candidate