Course Applied For
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Selected Subjects
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Full Name
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Father's Name
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Mother's Name
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Full Address
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Pincode
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Contact No.
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Email address
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Date of Birth
Birthplace & District
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Resident of Uttar Pradesh For how many years?
Category
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SC
ST
OBC
General
Sub Caste
Are you Ex-Servicemen / Freedom Fighter / Handicaped ?
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If yes, write category
Gender
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Male
Female
Father's / Guardian Occupation
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Married / Unmarried
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Previous Educational center
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Special Ability
Educational Qualification
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High School Detail
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Intermediate Detail
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Graduation Detail - Optional - Fill if Graduate
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DECLARATION I hereby declare that the information given in the Application form is true to the best of my knowledge and belief. If any information is found to be wrong, i shall be liable for action. I hold myself responsible for the due and prompt payment of fees.
