CHANDANNAGAR INSTITUTE OF MANAGEMENT & TECHNOLOGY

PALLYSHREE, STATION ROAD, CHINSURAH, HOOGHLY- 712102

APPLICATION FORM FOR ADMISSION INTO BBA/BCA

For The Session 2020-2023

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Applied for the Trade:

*Name(In Block Leter):

*Gender

*Category

*Date of Birth:

*Nationality:

*Permanent Address:


*Land Mark.:

*Pin Code.:

*P.S.

*Email Id:

*Mobile Number:

*WhatsApp No:


*Present Address:

*Land Mark:

*Pin:

*P.S.:

Land Line No:

*Nearest Railway Station:


*Father's Name:

*Father's Occupation:

*Father's Mobile No:

*Father's Whats App No:

*Father's Annual Income:

*Mother's Name:

*Mother's Occupation:

*Mother's Mobile No:

*Mother's Whats App No:

*Mother's Annual Income:


*Guardian's Name:

*Local Guardian's Name:

*Mobile Number:

*Whats App Number:


*Educational Qualifications

Sl.no Examination Passed Board/Council/University Medium Of
Study
Year Of
Passing
Percentage of Marks Division
1 Class X
2 Class XII

Other Qualifications(if any)

Extra Curricular Activities:

Language Known(Speaking/Writing/Reading):

*Marks Obtained in: Mathematics/ Computer Application/ Computer Science in Higer Secondary Examination(Only for B.C.A. Candidates)


*Signature of the Candidate

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*Signature of the Guardian

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