Application Form

The candidates can obtain the Application Form in person or by post by a Demand Draft of Rs. 500/- (Rupees Five Hundred only), payable at Laxmeshwar favouring' The Principal, Smt. Kamala & Sri Venkappa M. Agadi College of Engineering and Technology'.

The candidates can also download the Application Form from our website, www.agadiengcollege.org and submit the same along with a Demand Draft for Rs. 500/-, as above.

	COLLEGE OF ENGINEERING & TECHNOLOGY, LAXMESHWAR Dist Gadag Karnataka - Pin - 582116 APPLICATION FOR ADMISSION         (PROVISIONAL)                                                                                              No.
To, Principal (Admission Manager) Smt. Kamala & Shri Venkappa M. Agadi College of Engineering & Technology, Laxmeshwar Passport size Photo   Sir, I hereby apply for admission to I Semester, Engineering Degree Course. My order of preference Branch wise is as follows : (i) (ii) (iii) (iV) I agree, if admitted to conform to the rules and regulations of the college. (Signature)                                                                                        Yours faithfully,                                                                                             (Signature)     Place :   Date :        Name of the Applicant                                                PARTICULARS          1. Name of the applicant in full :   (in Block Letters) (Surname )  (Name)  (Father's Name)       MALE FEMALE   2. Place of Birth      Taluk :   District :       3. Date of Birth        4. (a) Nationality :   (b) Religion :   (c) Sub caste :       5. Permanent Home Address : (Block letters)         Pin Code :   Ph.No. & STD   Mob :       6. Local Address         Pin Code :   Ph.No. & STD           7. Parent's/Guardian's Name         Address:    Ph.No. & STD               Occupation                Examination Name of the Board/University Year of Passing Percent Institute / Centre   S.S.L.C   P.U.C. II/Diploma   Ist Semester   IInd Semester   IIIrd Semester   IVth Semester         The Particulars supplied by me in this application are correct to the best of my Knowledge     Date : Signature of the Applicant.     ENCLOSURES : 1. 2. 3. 4.