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 favoring’ 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

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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.