B.TECH
Application
2017-2018

APPLICATION FORM FOR B.TECH ADMISSION 2018-19

18/01/2018

(Fill in the blanks or put tick () wherever applicable)

1. Name of Candidate

2. Address for Communication

Pin:

Mobile:

E-mail:

3. Branch opted for admission

  • CE

  • CS

  • EC

  • ME

  • SB

ELIGIBILITY

  • Pass in any +2 like Kerala +2, Kerala +2 VHSE, +2 CBSE, +2 ISC or Equivalent.
  • 45% aggregate marks for Mathematics, Physics and Chemistry taken together.
  • Qualified/Rank holders of KEAM 2017 or KEE 2017 or JEE 2017 Students are eligible.
No Code Specialisation Branch
1 CE Civil Engineering
2 CS Computer Science and Engineering
3 EC Electronics and Communication Engineering
4 ME Mechanical Engineering
5 SB Naval Architecture and Ship Building

4. Admission Quota Selected

5. Name of Qualifying Exam

6. Year of Passing

7. KEAM 2017/CEE ENTRANCE

Roll No

Rank

8. KEE 2017/KERALA ENGINEERING ENTRANCE

Roll No

Rank

9. Date of Birth

10. Family Income

10. Whether belongs to SC/ST/OEC/OBC

12. Marks* obtained in qualifying examination

Marks Obtained

Maths, Physics, Chemistry put together

Maximum Marks

% of Marks

* Marks if not available now, shall be submitted within 10 days from publication of qualifying examination results.

13. (a) Name of Father

(b) Occupation

14. Mobile No Parent

+91

15. E-mail

Parent

Sl Type of Scholarship Sl Type of Scholarship
1 * CKC 2017 Merit type - 1 14 GATE Score Holders
2 # CKC 2017 Merit type - 2 15 KKRA – Kuzhoor Kara Residents Association
3 ~ CKC 2017 Merit type - 3 16 MCM - Merit Cum Means
4 AICTE TFW 17 MITEPPL - Muvattupuzha IT and Electronics Park Pvt. Ltd.
5 E - Grantz (SC/ST/OEC) 18 Parivarthana Christian
6 Award under Beedi workers welfare fund 19 Post Matric for OBC
7 Award under Cine workers welfare fund 20 Samunnathi for Forward Community
8 Award under IOMC workers welfare fund 21 Single Girl child under Indira Gandhi Scheme
9 Award under LSDM workers welfare fund 22 Single Girl child under Pragati/Saksham Scheme
10 Central Sector Scheme for College/University Students 23 Sitaram Jindal
11 Central Sector Scheme for Top Class Education for SC Students 24 Snehapoorvam
12 CH Muhammed Koya 25 Technolodge Muvattupuzha
13 Fisheries Department 26 TEDS - Technolodge Entrepreneurship Development Society

Rs. 5,500 per month for Food and Accommodation.
(Fully furnished, Daily clean/wet maintained, hygienic, centralised hot water, Medical assistance, Church/Temple travel by college bus, 24 hour generator backup, Wi-Fi, Round the clock digital library, Sharing accommodation, homely atmosphere, fresh and tasty homely food to requirement etc. ensures the hostel for most safe and better stay)

Rs. 4,500 per month for Food and Accommodation. (All above but dormitory accommodation)

Rooms with attached bath, Air conditioning etc are available on request on special rate.

DECLARATION

I, hereby declare that all the facts furnished above
by me is factual to the best of my knowledge.