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 *

Declaration

• I have not attended any other sponsored trainings as on date
• I understand that the training is of 160 Hours of Virtual Instructor Lead Training ( VILT ).

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.