NEHRU COLLEGE OF ENGINEERING AND RESEARCH CENTRE
(Approved by AICTE, New Delhi & Affiliated to Kerala Technological University, NAAC ACCREDITED & An ISO 9001 - 2015 Certified Institution)
Pampady, Thiruvilwamala, Thrissur Dist., Kerala - 680 588
Phone : 04884 - 284000, email : admissions@ncerc.ac.in, wwww.ncerc.ac.in

APPLICATION FORM

Application Form NO :

Year :

COURSES

B.Tech, M.Tech, MBA, MCA

Please ensure that the application form is completed in all aspects including the signatures of student and parent/ guardian. As the information given in the application form is most important for admission please take utmost care.

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CHOICE OF COURSE * :

PERSONAL DATA (IN CAPITAL LETTERS ONLY)

NAME * :

GENDER * :

MALE
FEMALE
TRANSGENDER

DATE OF BIRTH * :

BLOOD GROUP :

ADDRESS * :

PIN * :

MOBILE NO * :

E-MAIL * :

NATIONALITY :

RELIGION:

CAST :

COMMUNITY:

PARENTS NAME* :

PROFESSION :

ANNUAL INCOME : INDIAN :

OR US ( $ ) :

GUARDIAN'S NAME :

RELATION WITH GUARDIAN :

ADDRESS :

PIN :

MOBILE NO :

E-MAIL :

Any surgery undergone / physically handicapped

(If yes, Please mention in a separate letter about it)

NO
YES

ACADEMIC RECORD

HIGHEST QUALIFICATION :

SCHOOL / COLLEGE ATTENDED :

SCHOOL / COLLEGE ADDRESS :

PHONE :

YEAR :

NAME OF THE ENTRANCE EXAM :

ROLL No. IN ENTRANCE EXAM :

APPLICATION NO :

COMPOSITE SCORE :

ENTRANCE RANK :

CATEGORY :

ACADEMIC RESULTS

EXAMINATION	AGGREGATE % OF MARKS	YEAR OF PASSING	SCHOOL/UNIVERSITY
UG / DIPLOMA
+2 OR EQUIVALENT
SUBJECT	MARKS
PHYSICS
CHEMISTRY
MATHS
TOTAL
10TH / SSLC

JOINT DECLARATION BY THE STUDENT AND THE PARENT

I/ We have understood the prospectus, the rules & regulations, course details, recognitions, fees details, examination, board/university details, hostel/messs rules etc.
I know that I have to secure the attendance and internal marks as per the university norms for writing the University examinations.
I/ We know that I have to pay all my tuition fees/ Hostel & mess fees/ Transport fees/ any other dues in time, otherwise I/ We to pay late fees as fixed.
In case if am discontinuing / cancelling the course of any reason, I am abide the rule by the prescribed law.
I/ We know that proper dress code (uniform of the College) should be adhered to before entering the classrooms, laboratories or workshop on all working days.
I/ We that ragging and teasing is a criminal offence and is punishable.
I will not participate in any political activities, strike, Dharnas, Gharaos, Demonstration in the College campus or Hostel premises nor will I include other to do so. I will not indulge in any act which may result in damages or losses to the College or Hostel property or its prestige / reputation and will not conduct myself in any manner which will show disrespect to any staff, inmates or hostel authorities.
I / We know that smoking or usage of drugs, alcohol or any substance which is injurious to health are strictly prohibited within the College campus. If violated, serious action shall be initiated.
I / We know that I have to abide the vehicle rules as per the institution and Govt. law and parking shall be done only in the designated parking area, after getting vehicle parking pass.
I / We know that the usage of mobile phones are banned inside the class rooms/ laboratories/ workshops and library. Carrying mobile phones to examination halls are strictly prohibited and punishable crime.
I / We know that all the rules & regulations and policies of this College is binding on us and undertake to obey during my studentship in this Institution. If I / We violate such norms we are liable to face the Legal and Statutory consequences.

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Name & Signature of the Candidate