Registration Fee

General - ` 100/-
100/- GOVERNMENT OF KARNATAKA 42. RECENT
SC/ST/CAT-1 - ` 50/-
50/-
DIRECTORATE OF TECHNICAL EDUCATION PASPORT SIZE
APPLICATION FORM FOR ON-LINE INTERACTIVE ADMISSION TO DIPLOMA COURSES FOR THE YEAR 2019-20 COLOR PHOTO
(Before filling the application form, Please read the item – wise instructions as given in the brochure)

1. SATS No. 2.SSLC or EQUIVALENT REGISTER No.

3. Name of the candidate

4. Date of Birth

5. Name of the Father

6. Name of the Mother

7. Gender 8. Address
Male Female Others Name …………………………………………………………………………………….
9. Telephone Number
a) Landline Address …………………………………………………………………………………

City ………………………………………………………………………………………..
b) Mobile
State ……………………………………………………………………………………..
c) E-mail
Pin Code

10. Indian Nationality 11. Religion 12. Mother Tongue 13. Year of Passing
YES NO

14. Qualifying Examination SSLC CBSE ICSE Others 15. Native State Code

16. Native District Code 17. Code of the State Appeared for 18.Code of the District Appeared
SSLC / Equivalent for SSLC / Equivalent
19. No.of Years Studied 20.Total Max Marks 21. Total Marks 22. Percentage
In Karnataka in all Sub Obtained in all Sub

23. Marks in 24.Marks in 25.Total Max Marks in 26.Marks Obtained

Maths Science Science & Maths Science & Maths
27. Claiming Exemption From Yes No 28. If YES Mention 29. Claiming Rural Quota Yes No
5 Years Study Rule Clause Code
30. Claiming Kannada Yes No 31. Claiming SNQ Yes No 32. Claiming Horanadu Yes No
Medium Quota Quota Kannadiga Quota
33. Claiming Gadinadu Yes No 34.Application 35.Receipt No. 36.Amount
Kannadiga Quota Registration Fee Paid Date
37. Reservation 38. Name of 39. Annual 40.Claiming Yes No
Category the Caste Income Hyd-Kar Quota

41.Special Category Code: NCC JTS JOC EDP DP PS SP ITI Trade

SG PH AI CI

DECLARATION
We declare that the information furnished is true and correct to the best of our knowledge

Signature of the Parent/Guardian Signature of the Candidate