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

APPLICATION FORM FOR POLYCET-2017

(For State of Andhra Pradesh)

10th Class Hall ticket No. Paste the

Passport size
Year of Passing Board Photograph in this box
SSC/CBSE/ICSE/NIOS/APOSS

Date of Birth
D D M M Y Y Y Y Do not Staple/pin
a. Read the instructions given on the back side of the form. Do not sign on the
Photograph
b. Use Code only for item No. 4, 6, 7 & 9 as shown in the back page

1. Name (In Block Letters as per SSC)

2. Father's Name

03. Date of Birth 04. Sex

05. Address for Correspondence Aadhar No:

House No.

Village / Street

Mandal / Town / City

District
PIN

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

06. Local / Region 07. Reservation Category

08. Special Category NCC SP PH CAP

09. Minority Community 10. Willing to have assistance in Urdu Medium

11. I declare that I fulfill the eligibility criteria laid down for appearing at POLYCET-2017 and I shall submit all the original
Documents in proof at the time of admission into Polytechnics for the academic year 2017-18. I also certify that I am not
suffering from any of the following defects, (a) Mentally Retarded (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 Code Expansion
04. Sex M male
F Female
06. Local/Region AU Andhra University Area
OU Osmania University Area
SVU SV University Area
NL Non-Local
07 Reservation Category 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
08. Special Category If eligible place a tick mark ( )
in the respective boxes
09. Minority Community Christian
Muslim
Parsi
Sikh
Buddhist
Anglo Indian
Any Other
10. Willing to have assistance in Y Yes
Urdu Medium N 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 on the photograph

3. Only codes should be entered in the 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 and Social/Computers and should be

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