K S R POLYTECHNIC COLLEGE

TIRUCHENGODE – 637 215

KSRPC ALUMNI ASSOCIATION

ALUMNI REGISTRATION FORM

Office
Use only
Reg No: DIP:[________ /____ /____ ]

Personal Details

1 Name

2 Name of the Father / Guardian

3 Date of Birth

4 Sex Male Female

5 Year of Study From To

6 Course / Branch

Address Details

Present Address Permanent Address

pin pin

Phone Phone

Email Mobile

8 Have you appeared for any competitive Examination Yes No

Qualifications acquired after leaving this college

Name of
Name of the college / Year of % of
Course Board /
institution Passing Marks
University
9
 Employment Details
Have you
got On Off To be
Others
placement campus campus employed
10 through
S.No Designation and Company Address Remarks

Entrepreneur Details
Have you become an entrepreneur Yes No
If Yes mention Details:
11 S.No Designation and Company Address Remarks

Marital Status
Married on Spouse name & qualification Chindren
12
Single

Extra Curricular Activities:

13

Any Other Relevant Information

14

Please Furnish few Alumni Details that you Know:

Name Degree Batch E-Mail Phone / Mobile No.

15

Date: Signature of the Alumni