SSM INSTITUTE OF ENGINEERING AND TECHNOLOGY

Dindigul-Palani Highway, Dindigul 624 002.

ALUMNI REGISTRATION FORM

Course
BE ME
Photo
Branch*
Automobile Engg. Civil Engg. CSE
ECE EEE Mechanical Engg.
Communication Systems Thermal Engineering

Name (Full Name) : ____________________________

Gender : Male / Female DOB :....../...../..........(dd/mm/yyyy)

Father's Name : ____________________________

Mothers Name : ____________________________

Registration No. : ____________________

Year of Study : 2011-2015 2012-2016 2013-2017

: ____________________________
Address For Communication
(Permanent Address)
____________________________
____________________________

: ____________________________
Mobile Number (Please provide your 10 digit
number for communication)

Alternate Mobile Number : ____________________________

Email id
Alternate Email id
Details of Present employment
Please mention the following:
Designation
Name of the employer /department /
institution/ company with mailing address
(Enclose a copy of offer
letter/Appointment order)
: ____________________________
: ____________________________
: Private Sector / Govt. Sector / Higher
Studies/ Entrepreneur
:
:

Are you willing to nominate yourself in the list of office bearers of Alumni Association:
YES NO

If yes, provide your willingness to nominate as

President Vice president Secretary
Joint Secretary Treasurer Joint Treasurer
Executive members (two from each department)
Signature