DR.
BABASAHEB AMBEDKAR TECHNOLOGICAL UNIVERSITY LONERE-RAIGAD
Application form for ________ Convocation
(To be filled by all Appeared final year students)
1. PRN NUMBER :
2.
Class: Ph.D./M.Tech./M.Pharm./M.Arch./B.Tech./B.Arch./B.Pharm./B.Voc./Pharm.D./Pharm Practice/
Diploma/WQM/HMT
3. Branch : _______________________________________________________________________________________________________________
4. Applicants full name (As appeared on your Grade Report in English)
5. Sex : MALE/FEMALE (Please √ Tick)
6. Applicants full name in DEVNAGARI SCRIPT (As appeared on your Grade Report)
____________________________________________________________________________________________________________________________
7. Institute Full Name in DEVNAGARI SCRIPT (As appeared on your Grade Report)
____________________________________________________________________________________________________________________________
Academic Result Data
I II III IV V VI VII VIII
IX X
Credits
Grade
Point
CGPA
Passing
Season
&Year
8. Mobile No- ___________ _________________________ __ E-mail_________________________________________________________________________________
Director/Principal College Seal & Date Student Signature
(Signature)
