CENTRAL INSTITUTE OF TECHNOLOGY KOKRAJHAR (A Centrally Funded Institute under Ministry of HRD, Govt. of India) BODOLAND TERRITORIAL AREA DISTRICTS :: KOKRAJHAR :: ASSAM :: 783370
Website: www.cit.ac.in
A.
HOSTEL APPLICATION FORM FOR DIPLOMA/B. TECH /B. DES STUDENTS PERSONAL DATA: (Tick whichever/wherever necessary)
(1) Name of the Candidate: (Capital Letters)……………………………………………………………………………………. (2) Home Address: Vill/Town:…………………………………………..……...PO:……………………………………...……. Ward No:…………Dist:……………………………………State:…………………………PIN:………………………………
Paste a recent passport size Photograph
Applicant’sTel No. (M)……………………………………… (Email ID)……………………………………………………… (3) Mention Approximate distance from Home Address to the Institute…………………………………………………..….Km
(4) Date of Birth :( DD/MM/YY)…………………………………..(5) Nationality:
Indian
Foreigner
(6) Sex (Male/Female/Others):____
Vegetarian
Non-Vegetarian
(7) Food Habit:
B. ENROLMENT DATA: (1) Admitted into (Diploma/B. Tech/B. Des):- ________________ (2) Selected through (CITDEE/CITEE/CITBDAT/JEE/PAT/CITLET/UCEED:-___________ (3) Branch:- __________________
(4) Are you already Border of CIT Hostel?
Year:
Yes
1st
2nd
3rd
4th
Roll No:
No
If Yes,Name of Hostel………………………...………………………………………..…Wing No:…… ……………………...Room No………………… If No, mention current Year & Semester……………………………………………. C. ACADEMIC QUALIFICATIONS: Sl Name of Exam Passed Name of the Board/University No.
(Whether: Regular Student/Private Student/ Year Back Student)
Name of the Institute
Year of Passing
Division/Class
CGPA/% of marks
D. DECLARATION BY THE CANDIDATE: I,……………………………………………………………………………………………………..……………………………………..,hereby,declare that the information given above is true to the best of my knowledge and if any information furnished above is found incorrect, my admission is liable to be cancelled/expelled from the hostel and I shall abide by the rules and regulations of the hostel and the Institute. Date: E. FAMILY DATA: Signature of the Candidate. (1)Full name of the Parent/Guardian: ……………………………………………………………(2)Relationship: ……………………………………….. (3) Occupation: ………………………………..……... (4) Office Address: .……………………………………………………………………………….. (5)Designation: ……..…………………………………(6) Residential Address: Vill/Town:…… …………………………………………………….….. PO :………………………………………………Dist: ……………………………………………State : …………………………PIN :………………..… Email ID :………………………………………………………Tel. No. (With STD Code)…………………………….Mobile No: …………………..….. F. LOCAL GUARDIAN: Name and address of the person who should be contacted (in case of emergency): Name:……………………………………………………………………Address: …………………..…………………………………………………. Tel. No.. (With STD Code)…………………………………………………Valid Mobile No :…………………………………………………………….. G. DECLARATION BY THE PARENT/GUARDIAN:
I,……………………………………………………………….father/mother/guardian of Sri/Ms. ………………………………………………………… hereby declare that the statements furnished by my son/daughter are true to the best my knowledge and belief. I shall not interfere any decisions opted by the Institute against him/her found violation of rules and regulations or any misconduct. Date:
Signature of the Parent/Guardian For office use only
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Smoking :Smoking or consumption of tobacco, alcohol or drugs is strictly banned for the. students, parents, guardians and visitors in the school premises.
30 Jan 2018 - (GENERAL RECRUITMENT). PARA ± I: 1). $pplications are invited Online from qualified candidates through the proforma. $pplication to be made available on Commission's WEBSITE (www.tspsc.gov.in) to the post of. Hostel Welfare Officers Gr
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