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Diploma Admission (Common Application Form) - 2024
REFERENCE DETAILS
Referred By(Full Name):
BRANCH DETAILS
Select Branch Name:
Select Branch Name..................................................................
Civil Engineering
Electrical Engineering
Etc Engineering
Mechanical Engineering
Mining Engineering
COURSE DETAILS
Course Details:
Select Course Details.................................................................................
1-Diploma in Engineering
3-Diploma in Lateral Engineering
5-Both Diploma in Engineering & Lateral Engineering
APPLICANT DETAILS
Name:
Father's Name:
Mother's Name:
Blood Group:
Select Blood Group........
A+
A-
B+
B-
AB+
AB-
O+
O-
Not Known
Gender:
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Male
Female
Transgender
Religion:
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Hindu
Muslim
Christian
Sikh
Budhist
Jain
Parsi
Others
Date of Birth:
Aadhaar No:
Do you belong to BOC beneficiary?:
Yes
No
BOC Regd. No:
ADDRESS DETAILS
State Name:
Select State Name
1-Odisha
2-Bihar
3-Jharkhand
4-Telagana
5-West Bengal
6-Andhra Pradesh
7-Chhattisgarh
8-NCT of Delhi
9-Jammu & Kashmir
10-Uttarakhand
11-Himachal Pradesh
11-Tripura
13-Meghalaya
14-Manipur
15-Nagaland
16-Goa
17-Arunachal Pradesh
18-Pondichhery
19-Chandigarh
20-Mizoram
21-Sikkim
22-Andaman Nicobar
23-Dadra & Nagar Haveli
24-Daman & Diu
25-Tamilnadu
26-Madhya Pradesh
27-Rajasthan
28-Karnatak
29-Jajarat
30-Kerala
31-Punjab
32-Haryana
33-Uttar Pradesh
34-Maharshtra
35-Assam
36-Others
District:
Block/ULB:
Address:
PIN:
Mobile No:
Alt. Mobile No:
Email:
If E-mail not available then type "noname@gmail.com"
DOMICILE
Domicile:
Select Domicile..................................................................
Odisha State Applicant (S)
Outside Odisha State Applicant (Z)
Odia Living in outlying Odia Speaking Tracts (L)
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