Application Form
Select the Course you are applying for


1. Name: *
{{PhN}}
2. Gender *
Male
Female
Transgender
3. Date of Birth: *
4. Nationality: *
5. Religion: *
6. Applicant's Phone Number: * Invalid Phone Number!
7. Present Address:
8. Permanent Address:
9. Applicant's Father's Name: * 10. Father's Phone No: * Invalid Phone Number!
11. Applicant's Mother's Name: * 12. Applicant's E-mail: *
13. Family's Annual Income: *
(Copy of Certificate issued by appropriate authority must be submitted during verification)
14. Local Gurdians Name, Address & Phone Number: (If Any)
15. Category: *
(Self Attested Copy of Caste Certificate issued by appropriate authority must be submitted during verification)
General ST SC OBC MOBC
16. Name of the Institute last attended: *

17. Particulars of {{laststudied}} Examination passed: *
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Board/Council University Roll - No Registration Number Year
Hold on! that's not a year.


Bachelor Degree Details : *
Qualifying Degree:
Degree:
Do you have Major in? Yes No

Major Subject Name:

Electives:
Total Obtained: Total Marks: Percentage:
Subject Grand Total Percentage Division/Grade
Full Marks Not Allowed! Not Allowed! Not Allowed! Not Allowed! Not Allowed! Not Allowed! Not Allowed! Not Allowed!
Obtained Marks Cannot be greater than full marks Not Allowed! Cannot be greater than full marks Not Allowed! Cannot be greater than full marks Not Allowed! Cannot be greater than full marks Not Allowed! Cannot be greater than full marks Not Allowed! Cannot be greater than full marks Not Allowed! Cannot be greater than full marks Not Allowed! Cannot be greater than full marks Not Allowed!


17. Hostel Accomodation (For Girls Only): Required Not Required
18. Are you Differently Abled?:
(If YES Self Attested Copy of Certificate issued by appropriate authority must be submitted during verification)
Yes No
19. Applying for Extra-Curricular Quota?:
(If YES, the Hard copies of Supporting Documents must be submitted at the office four days prior to the date of admission)
Yes No
Extra Curricular Quota (The Hard copies of Supporting Documents must be submitted at the office four days prior to the date of admission )
Applied for: Sports Cultural Others

Prize Own

Representation

Formal Training (Sports/Cultural/Others)

National Level State Level District Level National Level State Level District Level Diploma Degree
20. Expected Subject-Combinations:
Compulsory Subjects Elective Subjects
20. Expected Subject-Combinations:
Subject Major Subject Elective Subjects
Choice 1 elective1 elective2 elective3
Choice 2 elective1 elective2 elective3
Choice 3 elective1 elective2 elective3
21. Upload Your Degree Marksheet: (Maximum Size 100KB)
21. Upload Your Recent Photograph: (Maximum Size 50KB)
22. Upload Your Signature: (Maximum Size 50KB)

Declaration:  I do hereby declare that all the above particulars are true to the best of my knowledge and belief. I shall be liable to be punished if any of the aforesaid particulars are found untrue. I further declare that I shall abide by the rules and regulations of the institution including the UGC regulation 2009 on curbing the menace of Ragging during my stay as a student.


By clicking on this Checkbox, you agree to the above statement.