Online Registration form

under Management Quota for the academic year 2014-2015

1. Full Name *
:
2. Date of birth * :
Date Month Year
3. Gender   :      
4. Religion :
5. Community :
6. Mother Tongue :
7. Address for Correspondance :
Region :
Country :
City/State :
Area :
Postal Code :  
Mobile No. * :
Phone No. with Country Code
Phone No. :
Email ID * :
8. Name of the Parent/Guardian :
8(a). Relationship with the Candidate
8(b). Contact number of the Parent/Guardian
9. Parent's/Guardian's Occupation :
Qualifying Examination Details
10. 10thstd. % : %
11. Month and Year of passing/passed in +2 :
12. XII std. Reg Number. :
13. Qualifying Examination (XII std.) : Appeared
Marks Obtained in XII std. (All marks should be filled in % only)
%
Physics
%
Chemistry
%
Maths
Select / Add one More Major subjects
%
Other
14. Medium of Instruction :
Other Details
16. Course(s) of Your Choice* :
Ist Preference IInd Preference IIIrd Preference
17. Where did you see our Admission Advertisement ? :
18. Whether hostel facility required :