RECORDS AS PER FORMAT MSRIT.

F 711 A ( Revision -1)

RAMAIAH The Department of Training & Placement

Institute of Technology M.S.R Nagar, MSRIT Post, Bangalore – 560 054
Phone: (080) 23604979, 23603120, 23600822; 23606312
Email: placement@msrit.edu and website : www.msrit.edu

REGISTRATION FORM FOR B.E STUDENTS

Name in Full:
Graduation Branch : Date of Birth: Sex:
Father’s Name, Occupation : Off. Ph.
And Office address
Mother’s Name, Occupation : Off. Ph.
And Office address
Education

Course Board Institution % Month/Year No. of C.E.T./COMEDK

Studied Marks of passing Attempts RANK / Mgmt
10th
Stamp-size
12th PHOTO
DIPLOMA
Attested by
HoD
Graduation (Month & Year of Completion): June/ July
USN :
Semester SGPA Year of Cleared in Semester SGPA Year of Cleared in
Passing Ist Attempt? Passing Ist Attempt
I Sem Yes / No V Sem Yes / No
II Sem Yes / No V1 Sem Yes / No
111 Sem Yes / No V11 Sem Yes / No
1V Sem Yes / No VIII Sem Yes / No
CGPA up to Semester =
Height: cm Weight: kg
Eye Sight: Left Right Blood Group :
Any year gap in education : If yes when and why :
Any plans for higher education : If yes specify, when and what course :
Any location preference for Job : If yes specify:
Computer Knowledge / Projects / Any Other Co – Curricular activities:

Address for Communication: Permanent Address :

Native Place:
District:
State:
Phone No: Phone No:
E-mail ID :
Category : SC / ST / OBC /GM: Physically Handicapped: Yes / No
I declare that the information given above is true to the best of my Knowledge & will up-date the
Marks, change in Telephone numbers, E-mail & Address

Date : Signature of the Candidate

Place:

Signature of HoD with seal