SOUTH DELHI POLYTECHNIC FOR WOMENFORMS FOR ADMISSIONS

Session 2015-2016

FOR OFFICE USE ONLY

Course offered:

Registration No:_________________Date:_________________

Last date for Payment of Fees:___________________________

Fees Receipt No:________________ Date:_________________

Hostel Facilities Required: YES / NO

Index No.:______________________

List the courses to which admissions are sought.(In order of preference)

1…………………………………………………………………………………………………….........................

2………………………………………………………………………………………………… ............................

To, The Director, South Delhi Polytechnic For Women, New Delhi -110024

I, the undersigned hereby apply for admission to the Polytechnic, subject to all the rules and regulations that may be applicable from time to time.

1. Full Name (In block letters please)……………….………………………………………..........................

2. Mother's Name…………...............................................Mother’s Profession........................................

3. Father’s Name…………………………..........................Father’s Profession........................................

4. Office Address & Tel. No …………………………….…………………………………..............................

5. Permanent Address & Phone (Both Mobile & Landline)......................... ……………..........................

.............................................................................................................................................................

6. Local Address & Phones..................................................………………........……...............................

7. E-mail………………………………………………8. Emergency Number : ……………….....................

Date of Birth………………………………………10. Nationality…………..…………..............................9.

Please stick onephotograph here(Do not staple it)Rest of the three

photographsshould be attached

alongwith form.

correct and authentic.I also certify that I have read all the rules and regulations in the Polytechnic and I shall abide by them. I

understand that any payment (including those of fees) will not be refunded by the Polytechnic. This is regardless of whether I join / do not join, after securing admission or discontinue during a term

........................................................... ......................................................................Signature of Student Counter-Signed by Parent/Guardian

UNDERTAKING-2

I______________________________________hereby declare without reservations of any kind, t hat I

as the responsible parent / guardian of_________________________________will not seek to hold Ashima Chaudhuri nor anyone employed by her, assisting her or connected in anyway with her Polytechnic, responsible for / in any mishap,to the student named above. This includes while at / proceeding to / from her Polytechnic in the Chartered Bus/or otherwise.

………………………………………… Address……………………………................Signature of Student ………………………………………..

……………………………………...... .........................................................

.......................................................... Signature of Parent/Guardian

Telephone Numbers……………....................

KINDLY NOTE: P lease do not enclose originals of any documents. Only attested photostat copies of originals must be submitted. In case of any difficulty

I hereby declare and certify that the particulars given by me above andanywhere else in the forms are

11.Particulars of previous and the last Examination appeared / passed.

UNDERTAKING-1

Last Examination appeard/passed

Name of Schoolor College

Year of appearingor passing

Marks in percentage or Division(If Results are awaited-mention)

in attestation, you may bring along your originals. Our Admission Officer or/and Admission Incharge, therewith shall attest the Documents.