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Student Application

Student Information:

Course Type *:

Course Name *:

Student Name *:

Middle Name:

Last Name *:

Date of Birth *:

Gender *:

Male Female Other

Marital Status *:

Unmarried Married

Personal Contact No (with Country Code) *:

Email ID *:

Fathers Name:

Fathers Contact No:

Mothers Name:

Mothers Contact No:

Guardian Name *:

Guardian Contact No *:

Student Address:

Parmanent Address *:

Pin/ Zip Code:

Country Name:

State:

District:

Check if(Same as Above):

Correspondence Address:

Pin/Zip code:

Country Name:

State:

District:

Academic Details

Highest Qualification:	Board Institute:	Marks Obtained:	Percentage of Marks:	Year of Pass:
Highest Qualification *:	Board/Institute *:	Marks Obtained *:	Percentage of marks(%) *:	Year of Pass *:

Other Academic Record

Qualification:	Board Institute:	Marks Obtained:	Percentage of Marks:	Year of Pass:

I certify that the above facts are true to the best of my knowledge and belief and I understand that I subject myself to disciplinary action in the event that the above facts are found to be falsified.