Registration
Student
Application Form
Course*
-- Please select --
BPT
Name (As in 10th Certificate)*
Aadhar No*
Gender*
-- Please select --
Male
Female
Blood Group*
-- Please select --
A+
A-
B+
B-
O+
O-
AB+
AB-
Religion*
-- Please select --
Christian
Hindu
Muslim
Caste*
Marital Status*
-- Please select --
Single
Married
Date of Birth*
Age*
Name of Father/Guardian*
Name of Mother*
Occupation*
Annual Income*
Permanent Address with District & Pin-Code*
Present Address with District & Pin-Code*
Parent's Mobile No 1*
Parent's Mobile No 2
Parent Email*
Student Mobile No
Email*
Educational Profile
Qualifying Examination
Name of the Board
Year of Passing
% of Marks
SSLC/Equivalent
Higher Secondary/Equivalent
Anti-Ragging Undertaking reference number obtained after online submission
Details of marks obtained in higher secondary examination
Subjects
Marks Obtained
Maximum Mark
% of Marks Obtained
Total of Physics, Chemistry & Biology
English
Physics
Chemistry
Biology
Mathematics
Upload Photo & Signature
Upload Photo* (Passport size photo (jpg or png) with 124px x 160px & maximum size 80kb)
Upload Signature* (Signature (jpg or png) size with 75px x 50px & maximum size 50kb)
Parent Signature* (Signature (jpg or png) size with 75px x 50px & maximum size 50kb)
I Declaration by the candidate: I do hereby declare that the information furnished above are true and correct to the best of my knowledge and belief.
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