Course applied for:*

Name (As it appears in the school records)

First Last

Gender

Male
Female

Date of Birth

Phone*

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Academic Details

10th Details :

Education Board

Name of School / College

Year of Passing

Stream / Specialisation

Percentage of Marks

Marksheet Upload

12th Details :

Education Board

Name of School / College

Year of Passing

Stream / Specialisation

Percentage of Marks

Marksheet Upload

Graduation Details :

Education Board

Name of School / College

Year of Passing

Stream / Specialisation

Percentage of Marks

Marksheet Upload

Family Details

Father's Name

Occupation

Contact Number

Where did you hear about us?*

Whether you require Hostel Facility?

Yes
No

Candidate's declaration

I hereby declare that the information given in the Application form is true to the best of my knowledge. If any information is found to be wrong, my Admission will stand cancelled and I am ready for any action taken by the institute. I hold myself responsible for the dues. I have noted that fee once paid is not refundable, under any circumstances.

Name

Place

Date

Application Form