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Name of Candidate:
Date of Birth:
Place of Birth:
Domicile:
Gender:
Marital Status:
Category:
Mode of Addmission:
Address of Correspondence:
Pin Code:
Mobile Number:
Resident Telephone Number:
E-Mail:
Permanent Address:
Any Medical Illness:
Bus Facility:
Family Details
Family Member Name Age Qualification Occupation Annual Income
Father
Mother
Brother
Sister
Qualification
(last four years)
Year School/College Board/University Exam Passed Subject Division %age
Hostel:
Any other information:
Entrance:
Rank:
Year of Appearing:
 
 
Undertaking
1 I hereby certify that the information given in the Registration form is complete and accurate. I understand and agree that any misrepresentation or admission of facts will justify the denial/Cancellation of admission.
2 I/We understand that the registration of my child ward is no guarantee of admission in the college. I have read instructions, rules and regulations and the fee structure carefully and hereby agree to abide by the terms & conditions stated there in.
3 I/We agree that if I default in payment to the college for any reason the amount outstanding against my ward will be payable by me and I am liable for that amount.
4 I/We agree that if I/We draw my ward after admission irrespective of whether the child has or have not attended the college even for a day after admission, the fees will not be refunded as per rules.
5 I/We bound myself to abide to follow the terms & conditions laid down in the prospectus & the amendment there in from time to time.
 
 
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ROORKEE COLLEGE OF POLYTECHNIC
09 Milestones, Roorkee-Dehradun Highway, Village-Kishanpur
Post Box No 104, Roorkee - 247667, Distt- Haridwar, Uttarakhand, India
01332-291088, +91-9412628358, +91-9412628358
directorrcppoly@gmail.com