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Registration Form

This document is an application form for admission to the B. Tech V Semester at the National Institute of Technology, Raipur for the Autumn Semester 2025. It requires personal information, academic history, and a declaration of the student's eligibility. The form must be signed by both the student and the Head of Department (HOD).

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aamkaachar1
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8 views1 page

Registration Form

This document is an application form for admission to the B. Tech V Semester at the National Institute of Technology, Raipur for the Autumn Semester 2025. It requires personal information, academic history, and a declaration of the student's eligibility. The form must be signed by both the student and the Head of Department (HOD).

Uploaded by

aamkaachar1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NATIONAL INSTITUTE OF TECHNOLOGY

RAIPUR (C.G.) 492010


Affix your
recent passport
APPLICATION FOR ADMISSION IN B. TECH. V SEM (CBCS SCHEME) size photograph
FOR AUTUMN SEMESTER 2025 here

NAME OF STUDENT........................................................................................................................................
LOCAL GUARDIAN ADDRESS.......................................................................................................................
FATHER’S NAME WITH HOME ADDRESS & PHONE NO. .......................................................................
..............................................................................................................................................................................
E-MAIL ID.......................................................... …... CATEGORY: GEN/ST/SC/OBC...............
YEAR OF ADMISSION IN THE NSTITUTE.................................................................................................
ROLL NO. ........................................................ ENROLMENT NO. .................................................................
....

CLASS AND BRANCH TO WHICH ADMISSION IS SOUGHT...................................................................


RESULTS OF PREVIOUS YEAR
SEMESTER BRANCH YEAR OF PASS WITH SUBJECT YET TO
CLEAR
1 SEMESTER
2 SEMESTER
3 SEMESTER
4 SEMESTER
5 SEMESTER
6 SEMESTER
7 SEMESTER
8 SEMESTER
9 SEMESTER
10 SEMESTER

DECLARATION BY THE STUDNET


I Submit this application for admission in B. Tech ..................... (n) semester. I have not been
detained in .................. (n-1) semester.
I have passed the examination of ............................. (n-4) semester and all semesters prior to this.
Above information is true to the best of my knowledge. If it is found false, my admission will be cancelled.

ADMITTED SIGNATURE OF STUDENT

SIGNATURE OF HOD

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