Website: www.chennaiinstituteoftechnology.com e-mail: info@citchennai.
net
Application No:
APPLICATION FORM FOR LATERAL ENTRY ADMISSION IN B.E. DEGREE COURSE 20 – 20
1. Name (in Block letters) :
(as in School Certificate)
2. Age & Date of Birth : Affix recent
Passport size
3. Birth Place : Photo of Student
4. Nationality :
5. Religion :
6. Mother Tongue :
7. Gender :
8. Name of the Parent/Guardian :
Father: Mother: Guardian:
9. Qualification and Occupation of the Parent / Guardian :
Father: Mother: Guardian:
10. Annual Income :
11. Permanent address Address for Communication
City: State: City: State:
Pin Code: Pin Code:
STD Code: Ph No.: STD Code: Ph No.:
Mobile: Mobile:
Email ID: Email ID:
12. Community : OC BC MBC SC ST Others
13. Course Applied :
Civil CSE ECE EEE Mech Mechatronics
14. Details of Qualifying Examinations :
Month & Year Percentage
Programme Institution University / Board of passing of marks /
CGPA
10th Std
HSC/
Intermediate
Diploma
15. Marks in Qualifying Examination
DIPLLOMA / EQUIVALENT QUALIFYING EXAMINATION
Subject Maximum Marks Marks Obtained Percentage of Marks
Semester 1
Semester 2
Semester 3
Semester 4
Semester 5
Semester 6
16. Extra Curricular Activities :
a) Sports :
b) NCC /NSS / YRC :
c) Others :
Parents Photo Guardian Photo
Affix recent
Passport size
Father Mother Photo
JOINT UNDERTAKING BY THE APPLICANT AND FATHER / GUARDIAN
1. The information furnished is true to the best of my knowledge. The original certificates will be
produced at the time of admission. In case if any information furnished is found to be incorrect we
agree to forego any claim for admission. In case any information found to be false at a later date
during verification, I / My ward will forfeit the admission / seat, no matter what stage of the
course/class at that time.
2. If admitted, we agree to be bound by the rules and regulations now in force and those to be
made from time to time by the college management, my ward will never make any loss or
damage to the properties of the institution.
3. We promise that we will not claim any compensation or refund of fees paid by us.
4. We also promise that we will do nothing either inside or outside the institution that will interface
with its institutional discipline.
5. We accept all decisions of the authorities in all matters of training contact, examinations and
discipline with no right of questioning in any court of law
6. We promise to abide by all the rules and regulations of your trust / College
7. We accept that any amount paid to the institution is nonrefundable after admission.
8. We accept that in case of my son / daughter wishes to leave institution in the middle of the
course, we will pay the fees for entire course before the issue of the transfer certificate.
Signature of Father / Guardian Signature of Applicant
Place :
Date :
CHECK LIST
1 Attested copy of S.S.L.C / Matric marks sheet
2 Attested copy of HSC / Intermediate
3 Attested copy of Community Certificate
4 Attested copy of Residence Certificate
5 Attested copy of Transfer Certificate
6 Attested copy of Mark Sheets
7 Interview Call letter
8 First Graduation Certificate
9 First Graduation Joint declaration
10 Passport size photos – 5 Nos
11 Nativity / Migration Certificate (For Other State Student)
Note : At the time of admission:
1. All Original Certificates must be submitted to the college authorities during admission
2. Three sets of attested Xerox copies of certificates should be submitted after arranging in the above order
3. Original certificates will not be returned to the students until the admission is approved by the DOTE.
4. Sufficient photocopies should be taken for student’s future needs.
FOR OFFICE USE ONLY
Quota: : Management Govt. Govt.-FG
(i) Qualifying examination : HSC / Intermediate
(ii) Has minimum Qualification : Yes/No
Physics / Vocational Chemistry / Vocational
Maths Total Percentage
Theory Practical
(iii) Results of Selection : ADMITTED / NOT ADMITTED
(iv) Branch Allotted : CIVIL / CSE / EEE/ ECE/ MECH / Auto / Biotech
(v) Date of Admission :
(vi) Remarks :
(vii) Verified by with name & Signature:
Notes :
i. Last Date for receipt of Application form : ……………………………..
ii. Incomplete and late applications will not be considered
