Rohtak Institute of Engineering & Management (B.Tech)

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Personal 1
Personal 2
Education 1
Education 2
Exam
Declaration
Documents

Personal 1

Your Name *

Stream Applied * Computer Science Engineering Information Technology Electronic and Communication Engineering Electronics and Electrical Engineering Mechanical Engineering

Date of Birth *

Email *

Mobile Number *

Phone No

Accommodation *

Category *

Religion *

Nationality *

Passport No. if Foreigner/ NRI

Passport Validity upto

Visa No.

Visa Validity upto

Personal 2

Father's Name *

Mother's Name *

Father's/Guardian's Phone No

Father's/Guardian's Occupation

Father's/Guardian's Annual Income

Mailing Address *

City *

PIN Code

State *

Country *

Education 1

Class 10th Board Name *

Class 10th School Name *

Class 10th Year of Passing *

Class 10th Marks (in %) *

Class 12th Board/University Name *

Class 12th Institute Name *

Class 12th Year of Passing *

Class 12th Marks (in %) *

Education 2

Class 12th Marks Obtained in Mathematics *

Class 12th Maximum Marks in Mathematics *

Class 12th Mathematics Marks(in %) *

Class 12th Marks Obtained in Physics *

Class 12th Maximum Marks in Physics *

Class 12th Physics Marks(in %) *

Class 12th Name of Other Subject 1 e.g.,Chemistry/Bio/Bio-tech/Comp.Sc./Info.Sc.

Class 12th Marks Obtained in Other Subject 1

Class 12th Maximum Marks in Other Subject 1

Class 12th Other Subject 1 Marks(in %)

Class 12th Name of Other Subject 2e.g.,Chemistry/Bio/Bio-tech/Comp.Sc./Info.Sc.

Class 12th Marks Obtained in Other Subject 2

Class 12th Maximum Marks in Other Subject 2

Class 12th Other Subject 2 Marks(in %)

Total PCM Marks(in %)

Class 12th Marks Obtained in English

Class 12th Maximum Marks in English

Class 12th English Marks(in %)

Exam

AIEEE Roll No

AIEEE Rank

AIEEE State Rank

Other Test Name

Other Test Roll No.

Other Test Rank

Declaration

I declare that all the information given in this application form is true to the best of my knowledge and nothing is concealed therein. I have read the rules and regulations of the Institute and I assure that I shall abide by all the rules and regulations which are in vogue now as well as those which come into force later from time-to-time. I further assure that I would do nothing inside or outside the Institute that would go against the discipline and orderly working of the Institute. I understand that if

Any information herein is found to be incorrect or
I am found indulging in any act of indiscipline or
I fail to pay the dues in time,

I shall be liable to any punishment awarded by the Institute; this may include striking off my name from the rolls of the Institute. * Yes

Documents

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