B S Channabasappa First Grade College

1. Student Name With Initials [Capital Only] :

2. Gender :

3. Date Of Birth :

4. a) Nationality :

b) Religion :

c) Caste :

d) Whether Candidate Belongs To SC/ST :

5. Place Of Birth And State :

6. Mother tongue :

7. Name Of The School Last Studied :

8. Class in which Student was studying at the time of leaving :

9. Medium of Instruction :

10. Number and date of Transfer Certificate:

11. Percentage of marks secured at the last Examination :

12. Class into which admission is sought :

13. Paticulars of Parents :

Father

Mother

a) Name :

b) Occupation :

c) Education Level :

d) Annual Income :

14. Address of The Parents :

15. Phone No :

16. Email :

17. Name and address of the local Guardian(only if the student is staying with a local Guardian) :

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