COURSE*

-------Select Course Name------ B.Sc. Nursing B.Tech -1st year B.Tech-2nd Year B.Tech-3rd Year B.Tech-4th year B.Voc -1st year Diploma - 1st year Diploma 3rd Year Diploma-2nd Year

Applicant's Personal Details /आवेदक का व्यक्तिगत विवरण

Applicant's Full Name / आवेदक का पूरा नाम *	Mr. Ms.
Father's Name / पिता का नाम *	Mr.
Mother's Name / माता का नाम *	Mrs.

Gender / लिंग*

Select One Male Female

Category / वर्ग*	Select One General/सामान्य Scheduled Caste/अनुसूचित जाति Scheduled Tribe/अनुसूचित जनजाति Other Backward Class/अन्य पिछड़ा वर्ग
Date Of Registration *

Contact Details / संपर्क विवरण

WhatsApp Number *	+91
Mobile / मोबाइल *

Email / ईमेल पता *

Photo *

Address Details / पता विवरण

Full Address / पता *
Pin Code / पिन कोड *

Student ID & Password

Aadhar Card Upload *

Declaration

* I , hereby declare that the particulars submitted by me in the Student Reg.