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NATIONAL INSTITUTE OF TECHNOLOGY

ROURKELA 769 008

RESUME SHEET

1. Full Name: Roll No.:[FIRST] [MIDDLE] [LAST]

2. Fathers Name:

3. Mothers Name:

4. Department: Blood Group:

5. Degree pursuing: B Tech M Tech (Res) MBA

M Tech M Sc (2 Years) MA

M Tech (DD) M Sc (Integrated)

Specialization:

6. Address @ NITR:

E-Mail: Mobile No.

7. Permanent Home Address:

VILL/@: POST:

P.S.: DIST.:

STATE: PIN:

TEL No.: MOBILE No.:

(STD Code) (Number)

8. Date of Birth: 1 9 Sex: Male Female

9. Nationality: Height: Weight:

10. Category: SC* ST* OBC* [*Copy of proof must be attached] GENERAL

11. JEE Mains Rank (for B Tech students

only):

GATE/JAM Rank (for M Tech/M Sc students only):

12. Mode of Admission

13. Academic Background (High School onwards):

Examination Year CPI or %age Institution Board / University Subjects taken

10th

12th

B Tech*

B Sc / B A*

(*For M Tech / M Sc / M A Students only)

14. Permanent Account Number (PAN):

15. Passport Details:

Passport No. ________________ Valid up to: ____________ Place of Issue: ______________

PTO

PHOTOGRAPH

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16. SGPA & CGPA (Attach a copy of your latest Grade Sheet):

I II III IV V VI VII VIII

SGP CGP SGP CGP SGP CGP SGP CGP SGP CGP SGP CGP SGP CGP SGP CGP

17. List of Professional Courses taken beyond present curriculum:(i) (ii)

(iii) (iv)

18. Details of Project Work / Summer Training etc.:

19. Scholastic Achievements:

20. Extra-curricular Activities:

21. Do you have any medical disability; including problems like eyesight, color blind, asthma etc.? If yes,

please mention in details.

22. Have you been in an ISDC hearing or faced disciplinary punishment of any kind? If any , mention them.

The information given above is true to the best of my knowledge.

________________ __________________________________

Date Signature of the Student