Directorate of Technical Education, Assam http://dteassamexam.in/dte/PAT2015/index.php?

menu=apply_online_pat

Directorate of Technical Education, Assam

Kahilipara, Guwahati-781019

POLYTECHNIC ADMISSION TEST 2015

APPLICATION FORM FOR ADMISSION INTO THE ENGINEERING DIPLOMA COURSES IN TH

Centre of Examination*

Name of the Applicant*

Father's Name*

Mother's Name*

Are you Physically Challanged?* Yes No

(Refer Pg.17 : Important Sl.No.5 & Pg.18)

Category*

Are you Grand-son/Grand-daughter of Freedom Fighter?* Yes No

(Refer Pg.17 : Important Sl. No. 2 of Information Brochure)

Are you Son/Daughter of Retired Defence Service Personnel?* Yes No

(Refer Pg.17 : Important Sl. No. 3 of Information Brochure)

Are you applying against Sports Quota?* Yes No

(Refer Pg.6 : Note 9 & 10 and Pg.17 : Important Sl. No.4 of Information Brochure)

Are you applying against N.C.C. Quota?* Yes No

(Refer Pg.6 : Note 7, 8 & 10 of Information Brochure)

Are you Son/Daughter of employees of Central Govt./Central Govt. Undertaking Service in Assam?[ Upto five years preceding
submitting Application form for Admission . (Only for Non-Resident of Assam)]*

Yes No

Are you Son/Daughter of an employee under Directorate of Technical Education, Assam?* Yes No

Date of Birth* Gender* Male Female

Details of HSLC or its equivalent Examination

Present status of Candidate* Appearing HSLC or its equivalent Examination in 2015

Already Passed HSLC or its equivalent Examination

Permenant Address

C/O*

Vill/Town/Ward*

P.S.*

District*

State*

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Directorate of Technical Education, Assam http://dteassamexam.in/dte/PAT2015/index.php?menu=apply_online_pat

Pin Code*

Mobile No*

Address for Communication Same as Permenant A

C/o*

Vill/Town/Ward*

P.S.*

District*

State*

Pin Code*

Mobile No*

Nationality* Religion*

Guardians name* Relationship*

Photograph of the Applicant* [File should be JPEG/JPG file. Siz

No file selected. Pref. dimentions 200x230(WxH)]

Signature of the Applicant* [File should be JPEG/JPG file. Siz

No file selected. Pref dimentions 140x60(WxH)]

I hereby declare that the information stated in the above are true and complete to the best of my knowledge
is found to be incorrect in any way, my admission shall be liable to be cancelled and authority can take any
me.

I Agree*

Change code

Enter the above number* (Don't put any space.)

Reset Submit

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