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1. Program Preference
Select First as '1' Second as '2'.
2. Name
Type your name in capital letters as given in your 10th standard certificate as shown in the example below.
3. Nationality
Click the appropriate option.
4. Category
Click the appropriate option.
5. Gender
Click the appropriate option.
6. Date of Birth
Select the date, month and year of your birth as recorded
in your 10th standard certificate.
7. Year of Qualifying Examination
Select the year of passing of qualifying (12th) Examination. For example, if passed in 2015
select 2015. Those who are appearing for qualifying examination in 2017 should select 2017 here.
 
8. Percentage of Marks
Enter the actual percentage of aggregate marks obtained in 10th and 12th standard if the results are available, otherwise leave
blank. The percentage should be rounded off to the nearest integer. For example 62.4% should be written as 62 and 76.5% as 77.
9. Board of Qualifying Examination
Click the appropriate box. In case of state board, write the name of the State only. In case of other, write the full name of the board.
10. JEE (Main) 2017 Roll Number
Enter your JEE (Main) 2017 Roll Number as it appears on your admit card.
11. Photograph of the candidate
Please upload only JPEG or GIF photo image of size 50 kb or less.
12. Signature of the candidate
Leave this blank. This space is for Office use only.
13. Name of the School
Type the name and details of the school where you have studied for the qualifying examination.
14. Postal Address
Type the name and complete postal address.
Contact Person  
Address line 1  
Address line 2  
City/Town     Dist.
State     Pin.
15a. Phone number
Enter 11 digit telephone number starting with ‘0’.    
 
15b. E-mail address
Enter your E-mail address IMP --> All the communication will be made on the email ID given by you.
                                                No seperate postal communication shall be done by DA-IICT.
15c. Mobile Number
Enter your Mobile Number    
 
16a. Domicile
Select your State of Domicile.
16b. Place of Residence
Select your place of residence.
17a. Mother's Name
Type your Mother's name in capital letters.
17b. Father/Guardian's name
Type your father/Guardian's name as in your Board certificate, if given. Write the name of your father, if no name is given in Board certificate.
17c. Relationship – with 17b above
Indicate your relationship with the name in para 17b.
18. Declaration by the Candidate
Click on the check box in support of your declaration.
19. Type this case sensitive string in the given box.
Type carefully this case sensitive alpha numeric string displayed on left side.
20. How did you come to know about DA-IICT
Click on the radio button in support of your specification. If you select "Other" then please specify in textbox.
 
© 2017 DA-IICT, Near Indroda Circle, Gandhinagar - 382 007, Gujarat, India.