Online Application form

NAME OF CENTRE
 
Certificate/Diploma Certificate Diploma
Password (10 characters maximum)
(Please remember this password as it will be required for editing your application and downloading admit cards at a later stage.)
Confirm Password (10 characters maximum)
(Password and Confirm password should be same.)

A. PERSONAL
NAME Ms./Mr.
FATHER’S NAME Mr./Dr.
MOTHER’S NAME Mrs./Dr.
SEX : Male Female Date of Birth
CATEGORY Gen ST NATIONALITY
OBC BC RELIGION (for statistical reports only)
SC    
If PC, Nature of PC OH VI Emergency Contact
HI None Phone No.

B. COMMUNICATION INFORMATION
MAILING ADDRESS PERMANENT ADDRESS
Is Permanent Address same as Mailing Address
STATE STATE
PIN CODE PIN CODE
Mobile: E-mail
PHONE NUMBER STD code:   Number:   Fax

C. ACADEMIC (First Row is Mandatory)
Name of Institution/Board Subject Examination Year Aggregate Marks%
(Without rounding off)
1) 
2) 
3) 

D. Important Scholarships, prizes and distinctions obtained (Example: NTSE, NRTS etc.)
Name of Award Year Reason for Award
1) 
2) 
3) 

E. DEMAND DRAFT (All Details are Mandatory)
DD No: Date Amount:
Issued by       Payable at