NATIONAL EDUCATION SOCIETY - JNNCE
NATIONAL EDUCATION SOCIETY ®
JAWAHARLAL NEHRU NATIONAL COLLEGE OF ENGINEERING
(ESTD. 1980)
SHIMOGA-577 204
(Affiliated to Visveswaraiah Technological University, Belgaum)
APPLICATION FOR ADMISSION TO B.E
DEGREE COURSE IN ENGINEERING
To,
The Principal
J.N.N. College of Engineering
SHIMOGA- 577 204.
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|Name of the applicant in full | |
|(Block Letters) | |
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|Name of the Father/Mother or Guardian | |
|(if parents are not alive) and official Address | |
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|a) Date of Birth | |
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|b) Age | |
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|a) Permanent Address & Phone No. | |
| | |
| | |
| | |
|b) Address for Communication & Phone No | |
| | |
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|a) Nationality | |
| | |
|b) Religion and Caste (State whether | |
|you belong to Scheduled Caste or | |
|Scheduled Tribe or Backward class or | |
|Backward Tribe or Special Group) | |
|(Caste is for Statistical Purposes only) | |
|a) Home –Town or Village | |
|(With pin code) | |
| | |
|b) Taluk | |
| | |
|c) District | |
| | |
|d) State | |
1. Occupation and Annual Income of the
Parents or Guardian (if Parents are
not alive)
2. Name and Address of local Guardian to
whom reference may be made in case
of need (other than local students)
Phone No.
9. Details of Educational Qualifications:
S.No. Institution Board/University Examination Passed Period of Study % of Marks
10. a) Name of the College/School
Last Attended
b) Address
c) Qualifying Examination Passed
(12th Std/II PUIC/B.Sc/Diploma)
d) Percentage of Marks
Subject in the
Qualifying Exam Max.Marks Min Marks Marks Obtained %
English
Optionals
Physics
Mathematics
Chemistry or
Computer Science or Electroncis
Percentage of Marks in Optionals
(all the three together)
11. Are the following attested copies of
certificates enclosed?
a. Tranfer Certificate
b. Marks Card of Pre-Unversity or
other Qualifying Examination
c. Eligibility Certificate
d. Migration certificate
e. Rank obtained in Entrance
Test Conducted by Government
of Karnataka
f. Medical certificate from a Registered
Medical Practitioner
g. Character & Conduct Certificate
NOTE: ONLY attested copies of
The required Certificates are to be
enclosed with the application and
Originals are to given at the time
of admission.
12. Branch of Engineering which the applicant
prefers to select (State order of Preference)
COMPUTER SCIENCE & ENGINEERING
INFORMATION SCIENCE AND ENGINEERING
ELECTRONICS & COMMUNICATIONS ENGINEERING
ELECTRICAL & ELECTRONICS ENGINEERING
MECHANICAL ENGINEERING
CIVIL ENGINEERING
INDUSTRIAL PRODUCTION & ENGINEERING
TELECOMMUNICATION ENGINEERING
13. Extra Curricular activities.
(Supported by Certificates)
I promise to abide myself by the rules, regulation and orders of the college
authorities and the University. I request you to admit me to B.E Course.
I am aware that RAGGING in any form is PROHIBITED. If I am found indulging in any kind of such undesirable activities, I am liable measures such as dismissal from the college, removal from the Hostel and prevention from taking the
University Examination.
It shall be my responsibility to pay the tuition and other prescribed fees and charges due to the college and Hostel within the prescribed dates, failing which, I become ineligible to attend the classes and to appear for University Examination.
Place : Signature of the applicant
Date :
DECLARATION BY THE PARENT/GUARDIAN
I agree to the applicant’s admission to the First Semester B.E Course of your College. I shall be responsible for payment of all his/her fees and also conduct and good behaviour during the course of his/her stay in the college. I request the Principal to send the progress, performance, behaviour and attendance reports periodically.
Place : Signature of the Parent/Guardian
Date :
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Attested
Passport Size Photo
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