Polytechnic College

THIRUVALLUVAR POLYTECHNIC COLLEGE

Second Year First Year

APPLICATION FORM FOR DIRECT SECOND YEAR REGISTRATION

Application No. 20LE -

Admission No.:2020-21 / LE / :

Course :

Civil Engineering

Mechanical Engineering

Electrical and Electronics Engineering

Category :

General

Differently Abled

HSC Academic/Vocational Total Marks/10th passed and 2 years I.T.I. :

NAME :

Name of the Parent/Guardian :

Occupation of the Parent / Guardian :

Annual income of the Parent / Guardian :

ADDRESS:

Pin Code :

Mobile No :

Phone No:

E.mail :

DATE OF BIRTH

Sex :

Female

Male

Third Gender

Nationality

Native District :

Place of Birth :

Mother Tongue :

Religion :

Hindu

Muslim

Christian

Others

If Others,Specify?

Community

SC(A)

MBC & DNC

BC(M)

BC(O)

Certificate Number :

Designation of the Officer who issued the Community Certificate :

Sub Collector

RDO/PA(G)

Tahsildar

Dy.Tahsildar

Name of the Revenue Division :

Name of the Revenue Taluk :

Caste :

Marital Status :

Single

Married

Examination Passed :

HSC Academic

HSC Vocational

10th passed & 2 years ITI

Others

Year of Passing :

Marks obtained in HSC (Academic) Marks

Subject	Maximum Marks	Marks Obtained
Tamil or any other Language	200
English	200
Physics	200
Chemistry	200
Biology / Zoology	200
Mathematics / Botany	200
Total	1200

Marks obtained in HSC (Vocational) Marks

Subject	Maximum Marks	Marks Obtained
Tamil or any other Language	200
English	200
Mathematics	200
Physics	200
Chemistry	200
Biology	200
Name of the Vocational Course
Theory	200
Practical I	200
Practical II	200
Total	1200

Details of Studies :

S.No	Class	Month and Year of Passing	Medium of Instructions	Name of the School and Address
1.	X Std
2.	IX Std
3.	HSC / Equivalent

DECLARATION BY THE APPLICANT :

I,.....................................................(Name in full) Son/Daughter of.........................................................hereby solemnly declare that the information furnished in the statements given in the application and the enclosures are true, correct and complete.

Place : ..................

Date : ..................

Signature of the Candidate

Application

APPLICATION FORM FOR DIRECT SECOND YEAR REGISTRATION

Marks obtained in HSC (Academic) Marks

Marks obtained in HSC (Vocational) Marks

Details of Studies :

DECLARATION BY THE APPLICANT :

Thiruvalluvar Group of Institutions