Lateral_Application Form

GOVERNMENT OF TAMILNADU

DEPARTMENT OF TECHNICAL EDUCATION, CHENNAI 600025

APPLICATION FORM FOR ADMISSION TO SECOND YEAR DIPLOMA COURSES..

(For Special Reservation: Use separate Application prescribed for this purpose)

Application No.:	Registration No.:
Filled in Applications should be sent to the Pincipal of the Polytechnic colleges / Institution to which the Candidate seeks Admission
Last Date for receipt of filled in Application
(To be filled up by the Applicant)

HSC Academic / Vocational / IT Total Marks :

Name of the Polytechnic College Applied :

1 (a) Name of the Candidate (in Block Letters) :

1 (b) Name of the Parent / Guardian :

1 (c) Contact Number :

1 (d) Email Address :

1 (e) Address Communication :

2 Sex :

Male Female

3 Date of Birth :

4 (a) Name of the Community :

4 (b) Cast :

4 (c) SI No of the certificate :

4 (d) Designation of the Officer issuing the Certification with Date:

5 (a) Examinaton Passed

Code No	HSC Academic	HSC Vocational	ITI / Others	Year fo Passing
123

5 (b) Marks obtained in HSC / Equivalent Examination:

HSC (Academic) Marks			HSC (Vocational) Marks			MMV / Fitter / Electrician ITI
Subject	Scored	Out of	Subject	Scored	Out of	Subject	Scored	Out of
Part / Tamil or Language			Part / Tamil or Language			1
Part II English			Part II English			2
Part III Maths			Part III Maths			3
Physics			Physics			4
Chemistry			Chemistry			5
Elective			Name of the Vocational Course			6
Total			Theory			7
			Practical I			8
			Practical II
			Total

(if any mark certificate is found to be Bogus will lead to cancellation of admission at any stage of study besides)

6 Nationality :

8 Native District :

7 Place of Birth :

9 Mother Tongue :

DECLARATION BY THE APPLICANT

I (Name in full) Son/Daughter of hereby solemnly declare that the information furnished in the statements given in the application, and the enclosures are true, correct and complete. I further declare that should it be found otherwise. I will be liable to forfeit my seat and or removel form the rolls of the institution at whatever stage of study i may be besides making me liable for Criminal Prosecution

Place :

Signature of the Student

Date :

Signature of the Parent

GOVERNMENT OF TAMILNADU

DEPARTMENT OF TECHNICAL EDUCATION, CHENNAI 600025

APPLICATION FORM FOR ADMISSION TO SECOND YEAR DIPLOMA COURSES..

(For Special Reservation: Use separate Application prescribed for this purpose)

DECLARATION BY THE APPLICANT

Note: Please enclose Xerox copies of the Certificates along with the Application