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Course *

Session *

Category *

• SC
• ST
• OBC
• General

Bonafide Resident of *

Roll No. / Enrollment No. of Entrance Exam (CET) *

Rank / %age *

Name of Student (in Capital Letters) *

Date of Birth *

Martial Status *

• Married
• Single

Father's Name *

Mother's Name *

Husband's Name (If Applicable)

Father's Occupation & Office Address with Telephone No.

Husband's Occupation & Office Address with Telephone No. (If Applicable)

Address for Corespondence *

Permanent Address *

Student's Email ID *

Aadhar Number (attach copy of Aadhar)

Original Documents *

• 10th Marksheet
• Certi.
• 12th Marksheet
• Certi.
• Migration

Mobile Number - Student *

Mobile Number - Father/Husband *

Address of Local Guardian with Telephone No.

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