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All fields marked (*) are mandatory.

1.	JCECE / AIEEE ROLL NO.
2.	Choice of Branch	------- Select Courses ------ Computer Science and Engineering Electronics & Communication Engineering Mechanical Engineering Electrical & Electronics Engineering
3.	Name
4.	Date of Birth	Year     Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Date
5.	Age
6.	Father's Name
7.	Mother's Name
8.	Mailing Address (For response to application)
9.	Permanent Address
10.	Sex	Male Female
11.	Mother Tongue
12.	Nationality
13.	Name of the state from which you have passed / appeared at the qualifying examination:
14.	Category	SC ST OBC GEN Other   Other Specify
15.	Education Record	Examination Year of Passing University/Board Subjects Taken % Of Marks Matric/10th/SSLC High School Secondary School Examination of Equivalent Matric/10th/SSLC High School Secondary School Examination of Equivalent
16.	Name of Legal Guardian (If Father is not alive)
17.	Name of local guardian and Address:
18.	Relationship of guardian with applicant
19.	Father's Occupation & Designation
20.	Family member employment details
21.	Achievements in the field of SPORT / EXTRA Curricular Activities