institute of engineering & technology, lucknow
(an autonomous constituent institute of dr. A.P.J. Kalam technical university)
Student provisional registration form (2016-2017)
Step 1
Student Details
Step 2
Parents Details
Step 3
Other Details
Step 4
Hostel Details
Step 5
Confirmation
Student Details
*
-Required Fields
Student's Name
*
Gender
*
Male
Female
Student's Name (In Hindi)
*
Year of Admission
*
DEGREE SOUGHT
*
B. TECH
M. TECH
MCA
MBA
PhD
COURSE/ BRANCH
*
CSE
IT
Civil
EE
ME
EC
EI
Chemical
SEMESTER
*
1
2
3
4
5
6
7
8
University Roll No.
*
(Except First Semester)
Date of Birth
*
Street Address
*
State
*
District
*
Pin
*
Phone
*
E-mail
*
Parents Details
*
-Required Fields
Father's Name
*
Profession
*
Business
Service
Government Employee
Farmer
Annual Income
*
Under 2 Lakhs
2 Lakhs - 5 Lakhs
5 Lakhs - 10 Lakhs
Above 10 Lakhs
Mother's Name
*
Profession
*
House Wife
Business
Service
Government Employee
Annual Income
Nil
Under 2 Lakhs
2 Lakhs - 5 Lakhs
5 Lakhs - 10 Lakhs
Above 10 Lakhs
Guardian's Name
*
Profession
Business
Service
Government Employee
Father's/ Guardian's Address
*
State
*
District
*
Pin
*
Phone
*
Local Guardian's Name
(If Any) alongwith relationship
Local Guardian's Address
*
State
*
District
*
Pin
Phone
Other Details
*
-Required Fields
If student belongs to minority community
*
Yes
No
Detail
Whether belong to Rural or Urban area
*
Urban
Rural
Student's Cast
*
Student's Category
*
Sub-Category
OBC (Creamy Layer)
OBC (Non -Creamy Layer)
SC
ST
Whether admitted in
None of these
NRI Seat
Govt. Sponsered Seat
Blood Group
A+
A-
B+
B-
AB
O+
O-
Hoobies
Hostel Request
*
-Required Fields
Hostel Request
*
Yes
No
Hostel Name
*
A-Block
B-Block
C-Block
D-Block
E-Block
Room No. Request
Confirmation
Decleration
I undertake that the information submitted is true to the best of my knowledge and belief. I shall bear the consequences if any of them are found to be wrong.
Undertaking by the Student
I will attend all the classes from the opening day of the Institute and I will be regular and punctual to all the classes i.e (Theory/Practical) and i am aware that if I don’t secure attendance more than 75% I shall be detained and not allowed to appear for the Term End Examination.
