Aizza College of Engineering & Technology
Mulkalla, Mancherial, Adilabad (Dt), A.P.
  
STUDENT'S  REGISTRATION  FORM
For B.Tech Courses
  Select Course:  
    EAMCET Rank      
  
  Inter Marks:  
  Category:  
1. Name of The Candidate   (Capital Letters)
2. Fathers Name /Husbands Name
3. Occupation/Proffession of 
 a) Father/Guardian
b) Guardian Relationship of the Candidate
4. Annual Income of Father/ Guardian
5. Present Address with Tel No:
Name:
Email Id :
H.No:
P.O:  
T.Q:
Dist:  
Pin code:    
Ph No:
6. Permanent Address with Tel No:
Name:
H.No:  
P.O:
T.Q:
Dist:
Pin code:  
Ph No:
7. Date Of Birth(as per SSC Certificate)         
8. Identification Marks 1
    2
     
9.    a) Mother Tongue    
     b) Nationality      
     c) Religion   
     
10.    a) State whether you belong to
    SC/ST/BC/BC-E/OBC
   (Produce a caste certificate from MRO)
  
    
     b) Caste     
     c) Sub Caste    
     d) Are you a scholarship holder?           
   If yes, furnish (i) Name of    the Scholarship         
   (ii) Proceeding No.        
   (iii) Amount received         
     
11.
     a) Name of the event     
     b) Whether you have played in any tournament        and have won a prize (Give details)      
     c) Whether you have represented the state or        have taken part in any National Championship
      (produce certificate)
     
     
12. Extra Curricular Activities
(Literary Association, Debates, Social Service etc. Certificate from  the Head of the Institution to be attached whereever required)
 
    
     
13. Remarks