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Courses Type

:
  Faculty :
 

Course Name

:
 

1.

Student's Name

:
2.

Father's Name

:
3.

Mother's Name

:
4.

Guardian's Name

:
5.

Date of Birth

:
-
-
6.

Medium

:
7.

Caste

:

Gen

ST

SC

OBC

  Gender :  
8.

Domicile of

:
9.

Place of birth

:

(a) Village / City

:

(b) District

:

(c) State

:
10.

Occupations

:

Father's / Husband's :

Mother's :

11.

Yearly Income

:

Father's / Husband's :

Mother's :

12.

Permanent Address

:
 

 

District : State : Pin:
.

 

Phone No.(with STD Code) :
 

 

Mob No.
 

 

E-mail Address
13. Student's Local Address
:
 

 

  District : State : Pin :
 

 

  Phone No.(with STD Code)
 

 

  Mob No.
14.

Guardian's Address

:
 

 

District : State : Pin:
      Phone No.(with STD Code)
      Mob No.
15. Duration of Father's / Husband / Guardian's Stay in UP-Years :
16. Details of Entrance Rxam Conducted by the Gov./ University
Name of Exam Roll No. Max. Marks Mark Obtained Percentage Merit Rank

17.Details of the Eduational Progress of the Applicant

Exam Year Educational Institute Name of Board /
University
Marks Obt/
Max.Marks
%age Division Subject

High School

Higher Sec

Graduation

Post Graduation

B.Ed.(For M.Ed.)

18. Optionals Subjects for Applied Course (If Applicable):

1. 2.
3. 4.

(Note : Incase of Incomplete details the form might be rejected.)
I hereby declare that the information given by me in this form and the certificates attached here with are true to the best of my knowledge and Belief.