Institution Name*
Course Name *
Student Name
Father's Name *
Mother's Name *
Gender * --Select-- Male Female
Martial Status * --Select-- Single Married
Aadhar Number *
Community * --Select-- OC BC MBC SC ST Others
Other Community *
Religion *
Physically Challenged --Select-- Yes No
Family Annual Income --Select-- Below 1 Lakh Per Annum Between 1 Lakh - 2 Lakh Per Annum Between 2 Lakh - 3 Lakh Per Annum Less than 3.5 Lakh Per Annum
Email-id *
Mobile Number *
Door No / Flat / Street *
Area / Location *
State *
District*
City *
Pin Code *
I declare that all the above details are true to the best of my knowledge. I intend to attend the scheduled training classes and would participate in all the events conducted as part of the Training program.