| Personal
Information |
| Name of the Candidate (To be typed with initials at the end as printed in HSC/SSLC Mark sheet) * |
Please
Enter Name as in HSC/SSLC Mark sheet with initials at the end. |
| Date of birth * |
The format is
dd-mmm-yyyy
(e.g..15-August-1995) |
| Gender * |
Select the relevant option. |
| Religion * |
Select the relevant option from the dropdown. |
| Community * |
Select the relevant option from the dropdown. |
| Mother Tongue* |
Select the relevant option from the dropdown. |
Particulars of Parents |
| Name of the Father* |
Enter the name of your Father. |
| Occupation of Father * |
Choose the appropriate option from the dropdown. |
| Name of the Mother * |
Enter the name of your Mother |
| Occupation of Mother * |
Enter the occupation of mother. |
| Choice of Programme of study (Subject to availability of seats) |
| Preference1 * |
Please select choice of program.
|
| Preference2 |
Please select Choice of program. |
| Preference3 |
Please select choice of program. |
| Address for Communication |
| Address Line 1 * |
Enter your Door number,
apartment number |
| Address Line 2* |
Enter your Street Name. |
| Address Line 3 |
Fill the locality Name. |
| City/Town/Village * |
Enter your city / town name. |
| State * |
Select the relevant option from the dropdown.
|
| Pin code* |
Please fill only numeric
characters (0-9). Do not leave spaces in between. |
| Phone Number (with STD code)For Eg.04465420117 |
Give your contact number with STD code. Do not leave any space in between the numbers |
| Mobile Number* |
If you have any mobile
number fill in this column. |
| Email ID * |
Fill your full email
address; for e.g ramesh@gmail.com. Don’t use email id of other persons. |
| Retype Email ID* |
Please retype the
Primary Email ID |
| Educational Information |
| Qualifying Examination* |
Select the relevant option from the dropdown. |
| Register Number |
Select the relevant Register Number. |
| Month & Year of Passing (For ex:Apr 2016)* |
Enter month & year of Passing. |
| Medium of Instruction* |
Enter medium of instruction. |
| Mathematics(%) |
Enter your mathematics percentage. |
| Physics(%) |
Enter your physics percentage. |
| Chemistry(%) |
Enter your chemistry percentage. |
Choice of Examination Centre |
| City / Town* |
Select your preferred choice of City/Town from the DropDown |
| Examination Date* |
Select examination date from the DropDown |
Upload Photo |
| Upload Photo(Only .jpg or .jpeg or .gif formats, Upto 150 kb)* |
You have to upload your image in the given format and size. |