APPLICATION FORM(PU Education Board Karnataka) For Office use onlyApplication No: Admission No: Enrollement No / Student ID: SATS ID: Note:Please Select only one combination of yuor choice & fill up the application form in Block Letter onlyRecent Passport Photograph(Max 500kb with 100dpi) Choose File YEAR FIRST YEAR PUC SECOND YEAR PUCSCIENCE PCMB PCMCLANGUAGE KANNADA HINDI FRENCHPERSONAL INFORMATIONName of the Applicant (As per the school record) Belong to APL/BPL Card – Select –APLBPLDate of Birth GENDER – Select –MALEFEMALENationality Religion Caste Category General SC ST OBC Physically ChallengedIf Category is OBC Select The Following Category – Select –Category 1Category 2ACategory 2BCategory 3ACategory 3BBirth Place Thaluk District State Aadhar Number Income Certificate No: Income as per Certificate: Caste Certificate No: Student Email Student Phone/Mobile No Mother Tongue Name of Father: Occupation: Phone/Mobile No Name of Mother: Occupation: Phone/Mobile No Name of Guardian: Occupation: Phone/Mobile No Total annual income PreviousNextAddress of Parent / Guardian Postal Address (Permanent)Address Line 1 Address Line 2 City State Zip Code Local Address (Communication)Address Line 1 Address Line 2 City State Zip Code OTHER DETAILSACADEMIC INFORMATIONFull address of the institution last Attended Percentage of marks obtained in SSLC:(Enclosed attested copy of marks card)Board of examination: SSLC ICSE CBSE OTHERSOthers Month & year Reg No ENTER THE CBSC SCORE CARD MARKSSubjectsMax.MarksMarks ObtainedClass / DivisionEnglish LNG & LITLANGUAGEKANNADASANSKRITFRENCHMATHEMATICS STANDARDScienceSocial ScienceOptional SubjectFood ProductionRetailingMarketing & salesPhysically EducationComputer scienceTotal MarksRESULTDistinctionFirst ClassSecond ClassThird ClassPassENTER THE ICSC SCORE CARD MARKSSubjectsTOTAL MARKS Max. Marks:100PERCENTAGE MARKSEnglish LNG & LITLANGUAGE – Select –KANNADAHINDIFRENCHMATHEMATICS STANDARDScienceSocial ScienceOptional SubjectFood ProductionRetailingMarketing & salesPhysically EducationComputer scienceTotal MarksRESULTDistinctionFirst ClassSecond ClassThird ClassPassENTER THE SSLC SCORE CARD MARKSSubjectsMax.MarksMarks ObtainedClass / DivisionLanguage 2 (English)LANGUAGE – Select –KannadaOthersLANGUAGE – Select –HindiOthersMathematicsScienceSocial ScienceTotal MarksRESULTDistinctionFirst ClassSecond ClassThird ClassPassAggregate Percentage Aggregate Percentage Aggregate Percentage Science and Mathematics Percentage Science and Mathematics Percentage Science and Mathematics Percentage Whether Language Exemption is taken in 10th std Yes NoMedium of instruction in 10th std – Select –KannadaEnglishSports Participated – Select –National LevelState LevelDistrict levelTaluk LevelNoneSports Activities: Cultural Participated – Select –National LevelState LevelDistrict levelTaluk LevelNoneCultural Activities: Extra-curricular Activities: Is Marks card Document Copy Uploded Yes NoEnclosed attested copy of marks card Choose File Is Income Certificate Document Copy Uploded Yes NoEnclosed attested copy of Income certificate Choose File Is Caste Certificate Document Copy Uploded Yes NoEnclosed attested copy of Caste certificate Choose File Is TC Certificate Document Copy Uploded Yes NoEnclosed attested copy of TC certificate Choose File I consent to have this website store my submitted information so they can respond to my inquiry Previous Submit Form
