Application Form.docx

Enrolment Form (For Classroom Programs)

Enrolment Number (for official use only) ________________________________

Registration Number : _____________________

PHOTO

Study Centre : ____________________________

(TO BE PASTED HERE)

Program Name : ________________________________________________________________________ Program Code : _________________________________________________________________________ Scholarship Awarded % (if applicable) : _____________________ Student’s Name (in Block Letters) : _______________________________________________________________________________________ Date of Birth : ________/_______/___________ E-mail ID : _________________________________________________ Mailing Address : __________________________________________________________________________________________ __________________________________________________________________________________________ Pin : _______________________________

Contact No (Mobile) : ____________________________

Permanent Address: __________________________________________________________________________________________ __________________________________________________________________________________________ Pin : _______________________________

Contact No (Mobile) : ____________________________

School/College Last Attended / Presently Attending : _____________________________________________________________________ Address : __________________________________________________________________________________________ __________________________________________________________________________________________ Pin : _________________________________ (a) Father‘s Name (in Block Letters) :_______________________________________________________ Qualification : ______________________________________________________________________________ Occupation : Business ( )

Govt. Service ( )

Pvt. Service ( )

Others (please specify) : _____________

Name of the Company / Office : _______________________________________________________________________________________ Nature of Business / Job : ______________________

Designation : ____________________________

Contact No (office) : _________________________________________ Office / Business Address : __________________________________________________________________________________________ __________________________________________________________________________________________ Pin : _______________________________ E-Mail ID : ________________________________

Mobile No : ___________________________

(b) Mother‘s Name (in Block Letters) : ___________________________________________________________ Qualification : ______________________________________________________________________________ Occupation : Business ( )

Govt. Service ( )

Pvt. Service ( )

Others (please specify) : _____________

Name of the Company / Office : _______________________________________________________________________________________ Nature of Business / Job : ______________________

Designation : ____________________________

Contact No (office) : _________________________________________ Office / Business Address : __________________________________________________________________________________________ __________________________________________________________________________________________ Pin : _______________________________ E-Mail ID : ________________________________

Mobile No : ___________________________

DETAILS OF THE EXAMINATION(S) OF THE CLASS LAST PASSED / CURRENTLY STUDYING Name of the Board Year of Total PCM / PCB/ Examination(s) passing / Aggregate Science + appeared Marks (%) Math (%)

Items required to be submitted along with this form :   



Four identical passport size colour photographs of the student One stamp size photograph. Any one of the following documents : a) Photocopy of School ID card with photograph b) Photocopy of last Board or School Marksheet supported by any Identity Proof of student c) Photocopy of Transfer Certificate d) Bonafide certificate issued by the Principal of School with student’s photograph Original should be presented for verification at the time of admission.