0480 2739800, 01, 02,
08156950403
nice@nirmalacollege.in

application for admission to B.Tech. degree course
Govt. Quota
Mgt. Quota
lateral Entry
NRI
1. Name of the candidate as in qualifying certificate *
2. Date of Birth*
Age*
3. Sex * Male Female
4. Nationality*
5. Religion*
6. Community*
7. Blood Group
8. Aadhar Card
9. Email*
10. Permanent Address *
Pin*
Telephone (with STD)
11. Address for communication *
Pin
Telephone (with STD)
12. Father's Name*
Occupation
Mobile No.
Official address with designation of Father (if employed)
Pin
Telephone (with STD)
13. Mother's Name*
Occupation
Mobile No.
Official address with designation of Mother (if employed)
Pin
Telephone (with STD)
14. Guardian's Name
Relationship
Mobile No.
15. Student's Email
Parent's Email
16. Courses applied for

(give order of preference) Write I for branch opted & 2,3,4,5 for others if desired

civil engineering
computer science & engineering
electrical & electronics engineering
electronics & communication engineering
mechanical engineering
17. Name of institution last attended
18. +2 exam passed
kerala HSE
VHSE
CBSE
ISC
Others (specify)
Register Number
Year & Month of passing
Total PCM
Percentage PCM
No.of chances taken
19. Details of marks secured in qualifying examinations (copy of mark list to be enclosed)
Subject Marks Obtained Max. Marks Result Division / %
Mathematics
Physics
Chemistry
Other
Total
20. Have you appeared for Kerala Engg. Entrance Exam
Yes No
If yes, Roll No.
Rank No.
Marks
21. Category (specify community)
SC
ST
OEC
OBC
EB
Others
22. Details of NRI sponsor (for NRI quota)
Declaration

    I hereby declare that the information furnished in the application form are correct to the best of my knowledge and belief. Note that the decision of the University is final with regard to the selection for admission. If selected for admission, I promise to abide by the rules and regulations of the University and college. Fee paid for admission will not be claimed back under any circumstance. If I intend to discontinue the course after joining, I hereby undertake to pay the course fee as applicable for the remaining years of my course.

Payment

    I agree to pay online(Application Fee Rs.500)







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