*
Marks Are Mandatory
Personal Details
Certificate Course
*
Select
Certificate Course in Embedded System Design
Applicant'
s Name
*
(
As it should appear on the certificate
)
Applicant'
s Mother Name
*
(
As it should appear on the certificate
)
Applicant's Sex
*
Male
Female
Date of Birth
*
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Month
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
/
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Caste Category
*
Select
S.C
S.T
NT-A
NT-B
NT-C
NT-D
SBC
OBC
OPEN
SEBC
EWS
Postal Address
*
Pin Code
*
Phone Number
-
Mobile
*
(
*
NOTE: Please enter valid Mobile No. for further Communication. eg. 9833180754)
Email
*
eg. test@yahoo.com
Incorrect EmailId
Preferable City for Entrance Exam
*
Select
Ahmedabad
Bangalore
Chennai CD
Delhi PV
Indore
Kolhapur
Kolkata
Lucknow
Mumbai Andheri(W)
Nagpur
Nasik
Secunderabad
Upload your photo
*
(Format:- jpg, Size:-160 x 120)
(
*
NOTE: Photo will print on Admit / Hall Ticket)
Educational Qualification of Highest Degree
Degree
*
Board / University
*
Year when appeared/passed
*
Aggregate Percentage of mark
*
Optimized for I.E. 7.0 and above at 1024*768