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    Directorate of Technical Education, Chhattisgarh संचालनालय तकनीकी िश ा, छतीसगढ़

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    bhupendra sahu
    This document is an application form for lateral entry into diploma engineering programs in Chhattisgarh, India. It contains personal details of the applicant such as name, date of birth, address, education qualifications, and program preferences. The applicant is applying for the 2020-2021 academic year and has selected Mining Engineering as their first preference. The form also lists the required documents for admission and safety protocols to follow during the admission process due to the COVID-19 pandemic.

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    Directorate of Technical Education, Chhattisgarh संचालनालय तकनीकी िश ा, छतीसगढ़

    Uploaded by

    bhupendra sahu
    128 views2 pages
    This document is an application form for lateral entry into diploma engineering programs in Chhattisgarh, India. It contains personal details of the applicant such as name, date of birth, address, education qualifications, and program preferences. The applicant is applying for the 2020-2021 academic year and has selected Mining Engineering as their first preference. The form also lists the required documents for admission and safety protocols to follow during the admission process due to the COVID-19 pandemic.

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    This document is an application form for lateral entry into diploma engineering programs in Chhattisgarh, India. It contains personal details of the applicant such as name, date of birth, address, education qualifications, and program preferences. The applicant is applying for the 2020-2021 academic year and has selected Mining Engineering as their first preference. The form also lists the required documents for admission and safety protocols to follow during the admission process due to the COVID-19 pandemic.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    128 views2 pages

    Directorate of Technical Education, Chhattisgarh संचालनालय तकनीकी िश ा, छतीसगढ़

    Uploaded by

    bhupendra sahu
    This document is an application form for lateral entry into diploma engineering programs in Chhattisgarh, India. It contains personal details of the applicant such as name, date of birth, address, education qualifications, and program preferences. The applicant is applying for the 2020-2021 academic year and has selected Mining Engineering as their first preference. The form also lists the required documents for admission and safety protocols to follow during the admission process due to the COVID-19 pandemic.

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    You are on page 1of 2

    10/27/2020

    Directorate of Technical Education, Chhattisgarh


    सं चालनालय तकनीकी िश ा, छतीसगढ़

    Indrawati Bhawan, Block-3, 4th Floor, Naya Raipur - 492002


    Phone :- 0771-2438666, 2221376, Fax :- 2253620
    Website :- http://www.cgdteraipur.cgstate.gov.in

    Application Form

    Lateral Entry in Diploma Engineering (DE), Costume Design & Dressmaking


    (CDDM), Fashion and Apparel Design (FAD)
    Print Date : 27/10/2020 : 22 : 49
    Phase: 2 Registration No : DIPL200033128 Version No : 1

    Personal Details
    Applicant Name : BHUPENDRA KUMAR
    Date of Birth : 15-Apr-1993
    Gender : Male
    Caste/Category : OBC
    Class : None
    Mobile Number : 7000681158
    Email Id : [email protected]
    Father's Name : NARENDRA KUMAR
    Mother's Name : PUSHPA SAHU
    Address Details Other Details
    VILL-MAHARAJPUR,
    POST-SINGHOLA,
    Address : Region : Rural
    DIST-RAJNANDGAON
    (C.G,)
    State : Chhattisgarh Religion : Hinduism
    District : Rajnandgaon Guardian Mobile No : 8878055338
    Pin Code : 491441 Domicile State : Chhattisgarh
    12TH Exam Details
    Roll Number 111000666
    Passing Year 2010
    School Name GOVT MULT H S SCHOOL RAJNANDGAON
    Board Name Chhatisgarh Madhyamik Siksha Mandal
    Total Marks 500
    Total Obtained Marks 300.000
    Percentage 60.000
    Subject wise Marks of 12TH Exam
    Pass with
    Subject Name Max Marks Obtained Marks Percentage
    Grace
    Physics 100.000 67.000 67.000
    Chemistry 100.000 70.000 70.000

    1/2
    10/27/2020

    Mathematics 100.000 51.000 51.000


    Application Details Applied On: 16-Oct-2020 07:52 PM
    Preference Course Name College Name Choice Code College Type
    Mining Engineering & Min Govt. Polytechnic, Balod (Mentor:
    1 16313 Government
    Surveying Engineering Govt. Polytechnic Dhamtari)
    List of copies of documents required to submit at the time of admission (Original documents and photo copy of
    original documents along with printed application cum option form and Allotment Letter must be shown at the time
    of admission
    1 10th Class Certificate or Birth Certificate
    2 12th Class Marksheet
    3 Domicile Certificate (Only in Proforma No. 5/6/7/8)
    4 Gap Certificate
    5 Permanent Caste Certificate (Proforma 1,2)
    6 Transfer Certificate (TC) and Character Certificate(CC)
    Declaration
    I have read "Admission Rules for Technical Institute's of Chhattisgarh-2020" and on understanding these rules, the
    application form is filled for consideration of allotment / admission to Lateral Entry in Diploma Engineering (DE),
    Costume Design & Dressmaking (CDDM), Fashion and Apparel Design (FAD) course for the academic year
    2020-2021. The information given by me in this application is true to the best of my knowledge and belief. If at later
    stage, it is found that I have furnished wrong information and/or submitted false certificate(s), I am aware that my
    allotment / admission shall be cancelled and I shall be subjected to legal and/or penal action as per the provisions of
    the law.

    कोिवड-19 सं मण के खतरे को ि गत रखते ए सोशल िड िसं ग एवं सु र ा मानकों का पालन िकये जाने
    हेतु सं था म वेश हेतु उप थत होने वाले आवेदकों के िलए िनदष:-

    1. आवेदकों को सं था प रसर म वेश हे तु मा लगाकर आने की अिनवायता होगी।


    2. सम अ थ को यं के साथ मा ] से नेटाइजर] पानी की बोतल एवं िटिफन की व था यं करनी होगी।
    3. आवेदकों को सं था प रसर म वेश ि या के दौरान उनके िलए िनधा रत मापद ों के अनु सार सोशल
    िड िसं ग का पालन करना अिनवाय होगा।
    4. केवल आवेदकों को सं था प रसर म वेश की अनु मित होगी। आवेदकों के अित र िकसी अ यों का
    वेश िनषे ध रहे गा।
    5. आवेदकों को सं था प रसर म वेश ि या के दौरान उनके िलए िनधा रत बैठक क के अित र अ
    मू मट की अनु मित नही ं होगी।

    Place: Signature of Candidate


    Date: ( BHUPENDRA KUMAR )

    2/2

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