Application Form
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Fields marked with*are mandatory.
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Personal Information
*Name of the applicant (As in the Matriculation Certificate)
Salutation (First Name) (Middle Name) (Last Name)
*Date of Birth *Gender Male Female
Religion Caste
*Nationality *Category
State of Domicile Name of Parish
Are you eligible for Arts Yes No Are you eligible for Sports Yes No
Marital Status
Note: Must attach Arts and Sports certificate along with the application form
Parent's Details
*Father's Name * Father's Occupation
Mother's Name Mother's Occupation
*Total Annual Income
Communication Address
*Address Line 1 Address Line 2
*Town/City *Country
* State
*District
*Pincode *Mobile No.
*Applicant's Email Address(Verification e-mail will be sent to this address) *Confirm Applicant's Email
Telephone
Permanent Address Same as Communication Address? Yes No
Permanent Address
*Address Line 1 Address Line 2
*Town/City *Country
*State
*District
*Pincode *Mobile No.
Telephone
Guardian Details (If Applicable)
Guardian Name Address Line 1
Address Line 2 Town/City
Country
State
District
Pincode
Mobile No Relationship with the
Applicant
Upload Your Photo
 
*Do you want to upload your photos now?     Yes  No 
   
Courses
*Please select Course category option   UG  PG 
*How do you propose to fund your Education?
Accommodation and Transport Requirement Detail
Note Subject to availability.
*Do you need hostel accommodation?     Yes    No   
*Do you need transport?     Yes    No   
   

HSC/Diploma Details

*Name of School *HSC Board
* Place and District *Year of Course Completion
Max Marks *Total marks for +2
Grade Obtained *Percentage of Marks
Class/Division Awarded

HSC/Equivalent Details

*HSC Board     Kerala  Others 

Note In Kerala syllabus the grand total marks out of 200 for each subject will be counted

*Registration No

Subject +2 Marks/Grade Obtained +2 Max Marks
Physics
Chemistry/Equivalent
Maths

Graduation Details

*Bachelor's Degree *Specialization
*Status *Year of Course Completion
*Institute/University * Place and District
Class/Division Awarded *Percentage of Marks
*Have you appeared in Kerala Engineering Entrance (KEAM)?     Yes    No   
*Have you attended the KEAM ? Yes  No   
   
Contact Details
Person Name Phone Mobile Email
*Self
*Father
Mother
*Guardian
Physical Details
Height (in CM) Weight (in Kgs)
Blood Group Physically Handicapped Yes No
Rank Details
Open Merit Rank Dalit Christian Rank
Community Merit Rank SC/ST Rank
Latin Catholic Rank Arts & Sports Rank

Gate Details

*Are you qualified in Gate Exam?     Yes    No   

Govt. Allotment Details

*Are you preferring Govt allotment?     Yes    No   

Work Experience

*Do you have any work experience?     Yes    No   
   
How did you know about us?
*How did you know about us?
Application enclosures
Note The following documents has to be submitted at the time of admission. The applicant is liable to produce any other document if demanded by the concerned authority.
1. SSLC Certificates.
2. HSC Certificates
3. Graduation Certificates.
4. Community Certificates
5. Income Certificates.
6. Entrance Score Card
*Payment Details
Cash payment
Demand Draft
Bank Payment
Declaration
 

I have carefully read the academic and administrative rules and regulations of the B.Tech. Program as given in the Information Brochure, Application Material &Prospectus and agree to abide by the same. I understand that these rules are only indicative and the complete list of rules and regulations as updated from time to time will be given to me on my admission in the form of Student Handbook and / or any other communication issued from time to time. I also understand that Vimal Jyothi Engineering College reserves the right to change/modify the rules and regulations from time to time and I agree to abide by the same. I agree to pay the fee as per the schedule of fee payment stipulated. I hereby declare that the information provided by me in the Application is true and correct to the best of my knowledge. My signature below certifies that I have read, understood and agreed to the rules and regulations of Vimal Jyothi Engineering College including 'Disclosure and Legal Aspects' (given on the last page), and my financial responsibilities.
I also will abide by the rules and regulations of the AICTE, University and state regarding the ragging, disciple,admission and separation.

*Place *Date

 
  I Agree  
   
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