Application Form
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Personal Information
 
*Name of the Applicant (As given in the matriculation certificate)
*Date of Birth *Gender Male Female Transgender
*Nationality *Mobile No.
*Physical Disablity(As per PWD Act, 1995) Yes No *Email Id
*Category *Confirm Email Id
*Alternate Mobile No.
Correspondence Address
*Address Line 1 *Country
Address Line 2 *State
Local Area *Town/City
*Pincode
*Permanent Address same as Correspondence Address ? Yes No
Permanent Address
*Address Line 1 *Country
Address Line 2 *State
Local Area *Town/City
*Pincode


Upload Photo and Signature
* Upload your passport size Photograph and Signature  here.
   
Education Details
Education Exam / Degree Specialization Medium Duration Institute City Result
From To Percentage(%) GPA out of Max GPA
* XIIth or equivalent
* Graduation
Post Graduation
Any Other

Work Experience Record (list current work experience first and proceed chronologically backwards)
*Name of Organization *Industry Type *Duration *Designation & Functional Area *Managerial Position *Annual Gross Salary (In INR) *Job Description
*From *To
Add More Details
Total Work Experience (In Years)
List key achievements of your professional career:
List setbacks, if any, of your professional career. What were your learnings?
Self/Career Improvement Efforts
If you have attended any self/career improvement programme please specify:
Programme Attended Duration Training Organization City Benefits Gained
Any awards or recognitions in academic life that you want to list
Award or Recognition detail Year Board/University/Recognizing Institute or organisation Details Comments, if any
Any awards or recognitions in professional life that you want to list
Award or Recognition detail Year Company/Recognizing Institute or organisation Details Comments, if any
   

Career Plan
Any other details that you wish to share
Declaration
 


    I clearly understand that if I am selected, I will be allowed to join the programme only if I satisfy all requirements of the Institute at the time of commencement of the programme.
    I certify that the particulars given by me in this form are true to the best of my knowledge and belief. I understand that admission granted on the basis of false and/ or misleading information will be ipso facto null and void. I agree to abide by the decision of the institute authorities regarding my selection/non-selection for the programme.

 
      Place
       Date
  I Agree  
Note: Please verify your details before click on Submit button below.
   
Familiy Details (Of Brothers and Sisters)
Relationship Name Occupation Educational Qualification
Awards and Recognitions in Academics and Sports
Awards Year Basis
Details of Teaching / Industrial Experience
Period Employer Position
Contact Details
Person Name Phone Mobile Email
Self
Father
Mother
Guardian
Physical Details
Language Proficiency
Type Language Writing Reading Speaking
Mother Tongue
Other Language I
Other Language II
Other Language III
   
How did you know about us?
How did you know about us?
*Payment Mode
Demand Draft
Application enclosures
Note Send the copies of the documents( 1 to 17) listed below along with the print out of the eform (filled) and send to the Principal, Lourdes Matha College of Science & Technology, Lourdes hills, Kuttichal P.O, Trivandrum - 695574.
1. E Form( Printout of the online application).
2. Mark list of the qualifying examination (Higher Sec or equivalent)
3. Pass certificate of the qualifying examination (if issued).
4. Eligibility Certificate from University (If Applicable)
5. Migration Certificate, if applicable.
6. Class 10th certificate in original to prove date of birth.
7. Attested copies of PLUS TWO and SSLC mark lists and certificates (2 No.s each)
8. Transfer Certificate from the School/College last attended.
9. Conduct Certificate from the School/ College last attended.
10.Admit Card of the Entrance Examination.
11.Rank certificate of the Entrance Examination.
12.Score card of the Entrance Examination.
13. Allotment Memo from CEE(for Govt. Merit Quota only).
14.Receipt of fee remitted in the Bank (for admission under Govt. Merit Quota).
15.Physical Fitness Certificate in the relevant format given in the KEAM Prospectus.
16. Income Certificate (for reservation category).
17.Community Certificate for SC/ST/OEC/SEBC.
18.Declaration from NRI sponser (For NRI Quota Only).
19.Copy of passport/employment certificate/Bank Statement (For NRI Quota Only).
20.Passport size photograph (Colour) 5 copies.
21.Family Photograph with parents 1 copy.
Joint Declaration by Applicant and Parent
 

I fully understand that "Ragging" is a crime and solemnly affirm that , Iwill not indulge in any form of Ragging. I hereby solemnly and sincerely affirm that, I have read and fully understood the rules and code of campus conduct of the college and I promise that I shall follow the same. If I contravene any of the rules and regulations of the College I am aware that I am liable to disciplinary action that the College Management may consider necessary and appropriate. Moreover, I hereby solemnly and sincerely affirm that the details, statements, date of birth and the information furnished by me in the application and enclosures submitted by me are true.

*Place *Date

 
  I Agree.  
   
Version 13.04.01