ACADEMIC YEAR

Preference Course Preference Course MBA MCA

Name in Full: Mr./Ms.

Date of Birth

Blood Group:

Mob

Mother's Name:

Mother Tongue:

Caste/Sub-Caste

Category:

Father/Husband's Name:

Occupation:

Permanent Address:

City

Dist

State:

PIN

Tel. No. (with STD code): (R).

(0)

Mobile (Parent):

E-mail(Parent):

Address for Correspondence:

City

Dist:

State:

PIN

Qualification Qualification X XII Graduation (Please Mention Degree) Post Graduation If any (Please Mention Degree)

Institution

Board/University

Duration To :

From

Major Subjects

% Marks Obtained

Class/Division

Programme

Degree/ Diploma/Certificate

Organising Body

Performance

Designation

Organization

Location

From-To

Hostel Accommodation: Hostel Accommodation: Required Not Required

Academic/Professional Accomplishments

Extra-Curricular Activites / Hobbies:

Place:

Date: