Institution Name *
Course Name *
First Name * Please Enter the First Name ! only characters allowed
Last Name * Please Enter the Last Name ! only characters allowed
Father's Name * Please Enter the Father Name ! only characters allowed
Mother's Name * Please Enter the Mother Name ! only characters allowed
Gender * --Select-- Male Female Please Select Gender !
Martial Status * --Select-- Single Married Please Select Martial Status !
Aadhar Number * Aadhar number should in numeric digits!
Community * --Select-- General OC BC MBC SC ST Others Please Select Community !
Other Community *
Religion * Please Enter Religion ! only characters allowed
Physically Challenged * --Select-- Yes No Please Select Physically Challenged !
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 Above 3.5 Lakh Per Annum Please Select Family Income !
Age * Please enter the Age ! Please Enter Only Numbers
University Roll Number * Please enter the University Roll Number !
Father Occupation * Please enter the Father Occupation !
Mother Occupation * Please enter the Mother Occupation!
Is the Student First Generation Graduate * Select Anyone Yes No Please Select anyone !
Is the Student a Single Parent Child * Select Anyone Yes No Please Select Anyone !
English Oral Communication Level * Select Anyone Beginner Intermediate Expert Please Select anyone !
English Written Communication Level * Select Anyone Beginner Intermediate Expert Please Select Anyone !
Year of Passout * --Select-- 2023 Please Select Year of Passout
Email-id * Please Enter the Email Address ! Enter a valid email id!
Mobile Number * Please Enter the Mobile Number ! Contact number should in numeric digits!
Door No / Flat / Street * Please Enter Door No / Flat / Street
Area / Location * Please Enter Area / Location
State *
District *
City * Please Enter the city !
Pin Code * Please Enter the area pincode ! Please Enter Only Numbers