STATE BOARD OF TECHNICAL EUCATION & TRAINING, A.P., HYDERABAD.

APPLICATION FORM FOR POLYCET-2015

(For State of Andhra Pradesh)
10th Class Hallticket No.
Year of Passing

Board
SSC/CBSE/ICSE/NIOS/APOSS

Paste the
Passport size
Photograph in this box

Date of Birth
a.
b.

D
D
M
M
Y
Y
Y
Read the instructions given on the back side of the form.
Use Code only for item No. 4, 6, 7 & 9 as shown in the back page

01.

Name (In Block Letters as per SSC)

02.

Father's Name

03.

Date of Birth

05.

Address for Correspondence

Do not Staple/pin
Do not sign on the
Photograph

04. Sex

House No.

Village / Street

Mandal / Town / City

District
PIN
Mobile Number

06.

Local / Region

08.

Special Category NCC

09.

Minority Community

05 (a): Town in which you would like to appear for examination

07. Reservation Category

SP

PH

CAP

10. Willing to have assistance in Urdu Medium

11. I delcare that I fulfill the eligibility criteria laid down for appearing at POLYCET-2015 and I shall submit all the original
documents in proof at the time of admission into Polytechnics for the acdemic year 2015-16. I also certify that I am not
suffering from any of the following defects, (a) Mentally Rtarfed (b) Deaf & Dumb (d) Deaf & Dumb (d) Chronic Heart, Lung,
Kidney, Liver Diseases (e) Muscular Dystrophy. The information furnished above is true to the best of my knowledge and
belief. In case any false information is furnished by me, I shall be made ineligible for admission and I will have no right to claim.

Signature of the Parent / Guardian

Signature of the Candidate

Item No.

Item Description

04.

Sex

06.

07

Local/Region

Reservation Category

08.

Special Category

09.

Minority Community

Code

Expansion

male

Female

AU

Andhra University Area

OU

Osmania University Area

SVU

SV University Area

NL

Non-Local

BCA

Back-ward Class - 'A' Group

BCB

Back-ward Class - 'B' Group

BCC

Back-ward Class - 'C' Group

BCD

Back-ward Class - 'D' Group

BCE

Back-ward Class - 'E' Group

SC

Scheduled Caste

ST

Scheduled Tribe
If eligible place a tick mark ()
in the respective boxes
Christian
Muslim
Parsi
Sikh
Buddhist
Anglo Indian
Any Other

10.

Willing to have assitance in

Yes

Urdu Medium

No

Instruction for filing up of Application Form for Computerization purpose

1.

Application form should be filled properly and legibly by the student in his/her own hand
writing with ball pen, (blue or black) in CAPITAL LETTERS only.

2.

Only good quality Passport size photograph should be pasted. Please do not staple or pin
the photograph. Please do not sign onthe photograph

3.

Only codes should be entereed inthe boxes provided against items 4, 6, 7, & 9 in the Application Form.

4.

Student has to choose the town/city in which he would like to appear for examination.

5.

APOSS/NIOS shall cover Mathematics, Science, Social/Computers and should be passed

in all subjects with a minimum of 35% in each subject.