For M.Tech/B. Tech. Course

ACHARYA NAGARJUNA UNIVERSITY COLLEGE OF ENGINEERING &TECHNOLOGY

ACHARYA NAGARJUNA UNIVERSITY:GUNTUR

Roll No. : ______(FOR OFFICE USE)

1.GENERAL

1.1Name: ______

Surname First Name Father’s Name
1.2Date of Birth : D

Day Month Year

1.3 Height : ______cms. Weight : ______kg. EAMCET/PGECET RANK ______
1.4Present Address : ______

______PIN

1.5Address for contacting: ______

(after annual examination) ______PIN
Phone (R) ______
1.6E-Mail Address : ______Mobile No.______

2.EDUCATIONAL QUALIFICATIONS

2.1Secondary and / or Higher Secondary

Examination /

Board / Institution

/ Year of Passing / Marks / No. of Attempt (s)
Obtained
/ Out of (Total) / %
S.S.C. or Equivalent / /
H.S.S.C. or Intermediate / /

2.2Under Graduation(For only M.Tech)

Examination /

Credits earned

/ Year of Passing /
No of Attempts
/
Percentage
Marks Obtained
/
Total marks
/
%
1stYear B. Tech. / / / /
2nd Year 1StSem. / / / /
2nd Year 2nd Sem. / / / /
3rd Year 1st Sem. / / / /
3rd Year 2nd Sem / / / /
4th Year 1st Sem / / / /
4th Year 2nd Sem / / / /
Total / / / /
Page 1 of 2
2.3Additional Qualifications, if any ______

3.FAMILY BACKGROUND : Please provide full details since the employer usually needs this information for record.

Relations / Name / Age / Education / Occupation if employed (Specify Designation & Office Address) / Annual
Income
(Approx)
Father
Mother
Brothers
Sisters

4.PRACTICAL TRAINING

Have you undergone practical training? Yes No.

If yes, provide details below

Sr. No. / Name of Organization / Period
From / To

5.EXTRA CURRICULAR ACTIVITIES

Sr. No. / Name of Activity / Level of Participation :
College/University/District / State/ National / Year of Participation

6.ADDITIONAL INFORMATION, IF ANY

______

______

______

Date : ------Signature ------

Page 2 of 2