Channabasaveshwara Institute of Technology

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Channabasaveshwara Institute of Technology
N.H. 206, B.H. Road, Gubbi, Tumkur 572 216
(Near Bangalore), Karnataka, India.
Tel : 08131 223818 / 223365 / 223144
Fax : 08131 223177
Email : hr@cittumkur.org,
              info@cittumkur.org
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ONLINE APPLICATION FORM


Name of the Candidate :
Father's/Guardian's Name :
Mother's Name :
Occupation of Father/Guardian :
Permanent Address :
Which Course You Selected  
Telephone No.(with STD/ISD code :
Mobile no :
Email Address (Parent/guardian) :
Email Address Candidate :
Nationality :
Religion :
Caste(SC/ST/OBC/GENERAL) :
Sex,Age & Date of Birth :      
State Of Domicile :
Mother Tongue :
Languages known :
Name of the qualifying examination :
Year and month of passing / appearing :
Board of examination :
10th Marks Percentage :
12th / PUC Total Marks :
Blood Group :
Hostel Accommodation required..? :
Extra curricular activities :