APPLICATION FORM - B. TECH. PROGRAM
2008 - 2009
EASTERN ACADEMY OF SCIENCE & TECHNOLOGY(EAST)
1. Read all the instructions carefully before filling up the form.
2. Do not Provide original certificates with the application form.
3. Attested Xerox copies of the Mark sheets must be enclosed.
Name
(In Block Letters) 		: (In Block Letters)
Sex :
Date of Birth
(DD-MM-YYYY)		 :
NRI / NRI Sponsored :
Local Address : (In Block Letters)
Permanent Address : (In Block Letters)
Email Address :
Pin code :
Phone Number  : (Area Code) (Number)
Mobile Number  :
Category  : General SC ST (Place Tick Mark)
Parent or Guardian Information :
Name :
Relationship :
Occupation :
Annual Income :
Telephone :
Mobile :
Email :
Local Contact Information :
Name :
Relationship :
Occupation :
Annual Income :
Telephone :
Mobile :
Email :