Gregorian Institute of Technology – Approved by AICTE, New Delhi

Name of the Student *

Date of Birth

Age

Religion

Caste

Department

Applicant Contact Number(Whatsapp No) *

Admission No

Batch No

Roll No

Semester

Regular Entry (Semester-1)

Lateral Entry (Semester-3)

Name of Mentor

Quota

Mode Of Conveyance

Blood Group

Father's Name

Mother's Name

Address with Landmark and PIN code

Mobile Number Of Father

Mobile Number Of Mother

Name of Reference 1

Relationship of the applicant to the Reference 1

Mobile Number of Reference 1

Name of Reference 2

Relationship of the applicant to the Reference 2

Mobile Number of Reference 2

Email Id

Occupation of Father *

Occupation of Mother *

Annual Income *

Siblings & their Status *

Ambition *

Hobbies *

Achievements *

Strength *

Weakness *

Upload Photo of Applicant

Upload Photo Of Parent

Upload Signature of Student

Upload Signature of Parent

I here by declare that all details provided above are true. I understand that any false information found will lead to the cancellation of my admission.

English
Maths
Physics
Chemistry
Other Main

Student Entry /Semester Registration & Mentorship Form

Marks or Grade secured in 12th/ITI/VHSE/KGCE

Marks or Grade secured in 10th

Subjects	Marks Obtained