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ADMISSION FORM The Principal Photograph Polytechnic for Women of A-3, South Extn. Part-1 Applicant Ring Road, New Delhi-! 10 049 Madam / Sir, After reading the Prospectus of your Polytechnic | have decided to apply for admission. | hereby undertake to follow all the rules and regulations of the Polytechnic. My particulars are given:below : Name (in block letters) Miss / Mrs. Father's / Husband’s Nami Father's / Husband's Occupation ~~ Poe Permanent Address ... 5. Telephone-No. (ifany).. 6. Present Address of Student. 7. Date of Birth’. 9. Nationality .. 10. State whether Schedule Caste ... 8, Single / Married / Widow ... ||. Qualifications Last Examination Name of Aggregate | Year of Passing/ Passed _| the Board/ %of > Appearing 12. Hobby of the Student. . 13. Course in which admission is —, (in order of Preference) Course Duration 14, [hereby certify that | am applying for admission with the consent of my Parents/ Husband and the information stated above is correct. | understand that fees once paid to the Polytechnic will not be refunded under any circumstances. I,also hereby declare that | will not seek to hold the Management or any employees of the Polytechnic responsible for any mishap to the student, while at or proceeding to or from her Polytechnic in the Chartered Buses. Signature of Parent/Husband Signature of Applicant Dated Dated FOR OFFICE USE ONLY Course ..... Duration .. Roll No. ... Receipt No. Date : Admission Incharge :

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