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APPLICATION FOR ADMISSION FOR I PUC PCMB/PCMC/PCMS/HEBA/EBAC/EBAS/HEPS
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* Indicates required question
1. Name of the applicant (In Block Letters) as per SSLC marks card:
*
Your answer
2. Date of Birth :
*
MM
/
DD
/
YYYY
3. Sex :
*
Male
Female
4. Place of Birth :
*
Your answer
5. Taluk and District :
*
Your answer
6. a) Father's Name :
*
Your answer
b) Mother's Name :
Your answer
C) Mother tongue of the student :
Your answer
7. Name and address of Parent/ Guardian :
*
Your answer
Village /Town :
*
Your answer
Post :
Your answer
Taluk :
Your answer
Dist :
*
Your answer
State :
*
Your answer
PIN :
*
Your answer
8. Mobile number of the Parent/Guardian:
*
Your answer
9. Whatsapp number of the student:
*
Your answer
10. Student E- Mail Address :
*
Your answer
11. Student Aadhar card number :
Your answer
12. Occupation and Income of the parent/ Guardian. ( If Applicable Please provide the certificate during admission) :
*
Your answer
13. a) Nationality :
*
Your answer
b) Religion :
*
Your answer
c) The Caste and Category to which you belong
*
SC/ST
Category-I
Category-IIA
Category-IIB
Category-IIIA
Category-IIIB
General
Sub-caste:
Your answer
14. Annual Income :
Your answer
15. Does he/she require hostel accommodation ?
*
Yes
No
16. Class to which admission is sought :
*
PCMB - Science
PCMC - Science
PCMS - Science
HEBA - Commerce
EBAC - Commerce
EBAS - Commerce
HEPS - ARTS
Required
17. Whether you have passed as a private candidate in SSLC :
*
Yes
No
18. Language desired under part I :
*
Kannada
Sanskrit
Hindi
19. a) Name of the previous institution through which the applicant appeared for qualifying Exam :
*
Your answer
b) Name of qualifying Exam and authority which conducted the qualifying Exam :
*
Karnataka SSLC Board
CBSE
ICSE
Others
Required
20. Are you studied in Karnataka :
Yes
No
21.SATS NO :
Your answer
22. Whether you have a Ration Card. If yes
APL
BPL
Clear selection
23. Date :
MM
/
DD
/
YYYY
Submit
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