please affix your recent passport size photo graph_ attestation

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					Institute for Electronic Governance - Jawahar Knowledge Center
                Student Application Form: 2009-10


Please Use Block Letters to fill application please read the instructions before fill the form
                                                                                                              Please affix your
Personal Details:
                                                                                                             recent passport size
University Hall Ticket No: ____________________________                                                          photo graph,
(Intermediate Hall Ticket No. in case of Degree first Year Students)
                                                                                                             Attestation required,
Date of Birth         D   D    M    M    Y   Y    Y    Y
                                                            Gender: Male            Female:                    do not staple the
                                                                                                                 photo graph
Religion: ___________ (Hindu/Muslim/Christian) Others ________________
Category (OC/BC-A/BC-B/BC-C/BC-D/SC/ST) _____________
Student Name ___________________________________________________________
             Surname               First Name                 Last Name
Family Annual Income______________
………………………………………………………………………………………………
College Details:
College Name: ____________________________________________ Location_________________
University (OU/AU/ANU/SVU/SKDU/KU) _______________ Others (Specify) ___________________
Group with Specialization (Ex: BSC - MPC) ____________________ District ___________________
Year of studying (first/second/third) _______________Year of Pass out (2010/2011/2012) _____________
………………………………………………………………………………………………
Contact Details:
H No: _______________ Street Name _____________________Village/Town ___________________
Mandal________________ District _________________ State _______________PIN _____________
Mobile Number ____________________ Land Phone No ______________________
Mail ID ________________________________ Alternate Mail ID _____________________________
…………………………………………………………………………………………….
Registration Fee Details:
(Each student is supposed to draw an individual DD of Rs. 500/- in favor of “Institute for Electronic Governance” and attach
the same along with the application form)
DD No ____________ DD Date ____________________ Bank Name ______________________
Note: No Registration fee for SC / ST students, copy of their caste certificate is to be attached along with the registration form

………………………………………………………………………………………………
                                                           For ID card                                        Please affix your
Hall Ticket No _______________                                                                               recent passport size
                                                                                                                 photo graph,
Student Name __________________________ Gender (Male/Female) _________                                       Attestation required,
College Name ________________________________ Location____________                                             do not staple the
                                                                                                                 photo graph
Group with Specialization (Ex: BSC (MPC) ___________
Year of Pass out (2010/2001/2012) _____________

                                                                                                                            Page 1 of 3
Institute for Electronic Governance - Jawahar Knowledge Center
               Student Application Form: 2009-10


Academic Details:
Academic Details       Year of Passing     Total Marks     Marks Obtained       Percentage    Number of Subjects failed in
                                                                                              the first attempt (0-All clear)
X Class
Intermediate
                                                Degree Academic Details
                                           Total Marks     Marks Obtained       Percentage
                       Year of Passing      (in group        (in group           (in group      Number of Subjects failed in
                       (Ex: 2009-10)        Subjects       Subjects only)        Subjects       the first attempt (0-All clear)
                                              only)                                only)
Degree – II Year
 Degree - I Year

Note: For Degree 1st year and 2nd year students furnish total marks in groups only. Marks in Languages should not be included

Please give the number of subjects to be cleared in failed subjects




       I declare that all the above details are true to the best of my knowledge. If the details are found to
be incorrect at any stage, I am liable to the penal action taken by Institute for Electronic Governance.



                                                                                          [Student’s Signature]



     I declare that the details given above are verified and found to be correct and his services can be
utilized by IEG for conducting seminars/workshops if the student selected by any company.



    [Placement Officer’s Signature]                                             [Principal’s Signature with Seal]



    I _________________________ Parent/Guardian of Mr/Mrs _____________________here by declare
    that I am aware of the JKC programs that IEG is conducting for the benefit of student and I am willing
    to join my Son/Daughter in to this program.



    Date:                                                              [Signature of the Parent/Guardian]




                                                                                                                      Page 2 of 3
Institute for Electronic Governance - Jawahar Knowledge Center
              Student Application Form: 2009-10
Instructions for Students:

Please follow below instructions to fill the Application Form

 1st, 2nd and final year students studying any Degree are eligible for registration. However
    eligibility criteria prescribed by individual companies will be final for selection into respective
    companies
 Each candidate is requested to take an individual DD towards the registration fee
 Candidates are requested to write their Hall ticket No, Name, College Name at backside of the
    DD with out fail.
 All fields are mandatory and use Block / Capital letters to fill the application form
 Provide the University Hall Ticket Number in case of 2nd      and
                                                                      3rd   year
                                                                                   students.1st year students should
    write Intermediate Hall Ticket Number.
 Provide Working E-Mail ID & Alternative E-Mail ID, to which you will receive communication form
    us about login details to access website, preparation material, information on eligibility and
    recruitments etc. Ex: annamayya@gmail.com, raju@yahoo.com
 Enclose Xerox copies of X class, Intermediate & Degree marks memos attested by Principal of the
    institution along with the application without fail.
 Candidates should submit their filled in application form along with DD to college principal /
    placement officer.
 Individual applications from sent directly by the candidates will not be accepted.
 Once the application along with the DD is received at IEG, registration amount will not be refunded
    under any circumstances.
Note:
 Candidates are requested to attend the trainings organized in their/other college by JKC Faculty
    Members/IT-Associates/Experts from IEG.
 Students are advised to work on the material provided by IEG to improve their skills designed on the
    basis of Industry feedback.
 Candidates should attend the Recruitment Drives organized by IEG.
 Candidates are requested to update their academic performance (I/II/III year marks) details form time
    to time by submitting the necessary documents (Xerox copies of Marks memo issued by University) to
    IEG.



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