STUDENT REGISTRATION FORM
Online Application Form
Full Name Of The Candidates
:
Category
:
--Select Category--
General
S.C
S.T
P.H
Green Card Holder
Ex-Serviceman Or Serviceman
Choose Your Course
:
--Select Course--
A.N.M
G.N.M
B.Sc.(N)
Computer Sc. & Application
B.Sc.(Physiotherapy)
B.Sc.(ITM)
BBA
Date of Birth
:
Age as on(the year of admission)
:
Nationality
:
Marital Status
:
--Select One--
Married
Un Married
Religion
:
Educational Qualification
:
Permanent Home Address
At
:
Po
:
Dist
:
Police Station
:
Pin
:
State
:
Phone
:
Present Address
Same as Permanent Address
At
:
Po
:
Dist
:
Police Station
:
Pin
:
State
:
Phone
:
Full Name Of Father/Husband
:
Occupation
:
Address
:
Guardians Name(If Father is dead)
:
Occupation
:
Address
:
Relationship with candidate
:
Phone No
:
Academic details
SL.No.
Name Of The Examn.
Name Of The Board/Council
Year Of Passing
Mark Secured Without Extra optional
% Of Mark Secure Without Extra optional
50% Of marks secured
1
2
3
4
5
6
7
1
H.S.C or it's Equivalent
2
+2 or it's Equivalent
I hereby confirm and declare that all information given here in true & correct and I shall accept all the terms and condition as started. I shall be bound and abide with the rules and regulations of organization.