Registration Form

INSTRUCTIONS:

  1. Please fill in the desired information clearly for all the fields.
  2. Please provide complete details for all mandatory fields.
  3. The fields with * are mandatory.
  4. You will need to attach a recent passport size photograph of yourself.
  5. To fill up the registration form you need to be nominated by your institution.

Personal Details

First Name * :
Middle Name :
Last Name * :
Gender *:
 Male  Female
Date of Birth * :
Country * :
Browse your photo *

Academic Details

Institute * :
Discipline/Stream * :
Year of Study *

Current Address

Address 1 * :
Address 2 :
Address 3 :
City * :
State * :
Pin Code * :

Permanent Address

Address 1 * :
Address 2 :
Address 3 :
City * :
State * :
Pin Code * :

Contact Details

Mobile No. * :
Landline No. :
Mobile No. (Father/Mother). * :
Email ID *(Personal email id) :

Family Information

Fill in the following details :
Family Member Name Profession Qualification
Father :
Mother :

Students Educational Qualification

Degree
From (Year) To (Year) Name of the Institute and location Board / University Major subjects Percentage Obtained/ CGPA
Class X *:
Class XII *:
Graduation *:
Post Graduation :
Explain breaks (if any) in your Education :
Name of Scholarship Year Scholarship Amount

Hobbies And Extracurricular Activities (Sports/Music/Theatre Etc.)


Area
Level
(School / College / State / District / Country / Other)
Achievement Time Period
(mention the years that you were associated with this area)
From (year) To (year)

Positions of Responsibility Held

Institute / School
Position Held Time Period
From (year) To (year)

BANK DETAILS

Student Name (as it appears in bank account) * :
Bank Name* :
Branch Name * :
Account No.* :
IFSC Code* :

Note : I hereby declare all the information provided in this application are true, complete and correct to the best of my knowledge and belief.


Full Name*

Date*

Place*

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