APPLICATION FORM

Course
School Applying for *
Course Applying for
Course Applying for
Course Applying for
First Preference - B.Tech/BE
Second Preference - B.Tech/BE
Third Preference - B.Tech/BE
Fourth Preference - B.Tech/BE
Fifth Preference - B.Tech/BE

Three preference of branches are compulsory

First Preference - M.TECH/ME
Second Preference - M.TECH/ME
First Preference - B.Tech(Lateral)
First Preference - BBA
Second Preference - BBA
First Preference - MBA
Second Preference - MBA
Personal
Name of the Candidate*
Email*
Mobile*
Gender*
Date of Birth *
Age *
Years
Whether CG domicile? *
Category *
Nationality
Differently Abled (PWD) *
Whatsapp Number
Family Details
Father's Name *
Mother's Name
Parent's/ Guardian's No. *
Mailing Address
Street *
Additional
State/Province *
District *
Postal Code
Country *
Permanent Address Same as Mailing Address?
Street
Additional
State/Province
District
Postal Code
Country
Academic Details
Qualification School / College Boad / University Location Stream Year of passing Aggregate % of Marks
10th
12th
Diploma
UG
PG
Other
Qualifying Exanimation
Name of Examination Roll Number Rank Score
Btech
CGPET - 2018
JEE-Main - 2018
Mtech / Phd (Engineering)
GATE
MBA / Phd (Managment)
CAT/MAT/XAT/CMAT/AT/MA
NET
MBA (WP) MBA (Working Professional) Minimum Working Experience 2 Year
Name of Company Location Date of Joining Designation Nature of Job
Other - Details
Photograph
Reference
I attended Open house of OPJU
Participated in CIC/SAT
I saw advertisement of OPJU
I searched OPJU on the internet
It was through reference
I recieve a call from OPJU
Have any of your friends/relatives has been associated with OP Jindal University / Jindal Group as the students or Staff? If yes then give the details:
Name:
OP Jindal University/ Jindal Group as staff
Student
Declaration

I hereby undertake that the information filled by me in the registration form are complete and correct to the best of my knowledge. I am fully aware that misrepresentation of facts in my registration form may render me disqualify for admission. I am aware that any dispute arising there of, is subject to the jurisdiction of Raigarh Courts only.

I Agree

* For any query please contact Mr. Dhananjay. M: +91-7869486540 For any technical query please contact Mr. Nitin M: +91 - 9109977030