Application Form

The candidates can obtain the Application Form in person or by post by a Demand Draft of Rs. 500/- (Rupees Five Hundred only), payable at Laxmeshwar favouring' The Principal, Smt. Kamala & Sri Venkappa M. Agadi College of Engineering and Technology'.

The candidates can also download the Application Form from our website, www.agadiengcollege.org and submit the same along with a Demand Draft for Rs. 500/-, as above.

   
COLLEGE OF ENGINEERING & TECHNOLOGY, LAXMESHWAR
Dist Gadag Karnataka - Pin - 582116
APPLICATION FOR ADMISSION        
(PROVISIONAL)
                                                                                             No.
To,
Principal (Admission Manager)
Smt. Kamala & Shri Venkappa M. Agadi
College of Engineering & Technology, Laxmeshwar




Passport size
Photo
 
Sir,

I hereby apply for admission to I Semester, Engineering Degree Course.
My order of preference Branch wise is as follows :

(i) (ii)
(iii) (iV)

I agree, if admitted to conform to the rules and regulations of the college.

(Signature)
                                                                                       Yours faithfully,
 
                                                                                          (Signature)    
Place :  
Date :        Name of the Applicant
 
                                             PARTICULARS     
   
1. Name of the applicant in full :
  (in Block Letters) (Surname )  (Name)  (Father's Name)
   
  MALE FEMALE  
2.
Place of Birth     
Taluk :   District :
     
3.
Date of Birth     
 
4. (a) Nationality :
  (b) Religion :
  (c) Sub caste :
     
5. Permanent Home Address :
(Block letters)
     
 
Pin Code :   Ph.No. & STD   Mob :
     
6. Local Address
     
 
Pin Code :   Ph.No. & STD    
     
7. Parent's/Guardian's Name
     
 
Address:    Ph.No. & STD    
         
Occupation         
     
Examination Name of the
Board/University
Year of Passing Percent Institute / Centre  
S.S.L.C  
P.U.C. II/Diploma  
Ist Semester  
IInd Semester  
IIIrd Semester  
IVth Semester  
     
The Particulars supplied by me in this application are correct to the best of my Knowledge
   
Date : Signature of the Applicant.
   
ENCLOSURES :
1.
2.
3.
4.
 
 
   
 

 
 
 

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