CMR INSTITUTE OF TECHNOLOGY

(A Division of CMR JNANADHARA TRUST)

132, Kundalahalli I.T Park Road, Bangalore – 560 037
Tel: (080) 28524477,28476936
Pre application No.

ADMISSION SOUGHT:
P.G: MBA MCA
U.G: B.E in ( Computer Science Information Science Electronics and Communication
Telecommunication Engineering Electrical and Electronics Engineering BioTechnology )
(PLEASE FILL IN BLOCK LETTERS)
I PERSONAL DATA

1. Name of the applicant

2.a. Date of Birth 2.b. NATIONALITY
DD/MM/YYYY
3. Sex MALE FEMALE
4.a Father’s 4.b. Father’s Occupation
Name
5. Permanent Address

Pincode

6. Email
7. Phone No with STD Code
8.a Guardian’s Name
8.b. Local Address

Pincode

8.c. Phone No with STD Code

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II ACADEMIC RECORDS
1. Institution Course Course Studied Year of Study CLASS &
Attended Attended % of Marks
FROM TO
I

SSLC/HIGH SCHOOL

II

PUC/ICSE/CBSE

III

DEGREE/DIPLOMA

2. Answer whichever applicable.

2.a. CET Details : Register No: Year: Rank No:

2.b. COMEDK Details : Register No: Year: Rank No:

2.c. Other Entrance Exam Details: Register No: Year: Rank No:

III ACHIEVEMENTS AND SPORTS

IV EXTRA CURRICULAR ACTIVITIES

Enclosures (CHECKLIST):
1. Copy of SSLC Marks Card
2. Copy of PUC/ICSE/CBSE Marks Card
3. CET/COMEDK Certificate

I hereby declare that the information furnished above is true to the best of my knowledge and belief and that if any
detail is found to be untrue or incorrect, I am liable to forfeit my admission along with all the fees paid.

PLACE:
DATE:

Signature of the Applicant

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