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STUDENT REGISTRATION FORM
STUDENT DETAILS
Name*
Father/Husband Name*
Gender*
Male
Female
Other
Date Of Birth*
(dd/mm/yyyy)
Mobile*
Category*
ST
SC
ANX-1
ANX-2
GEN
EWS
Enter Valid Email ID*
(Registration No. will be send.)
Upload Your Image*
(Max Size 100kb)
Image Preview*
CAST AND DOMICILE CERTIFICATE DETAILS
Cast Certificate Issued By*
(Only For Jharkhand)
NA
DC
SDO
Domicile Certificate Issued By*
(Only For Jharkhand)
NA
DC
SDO
CURRENT ADDRESS
Village/Mohalla*
Panchayat/Ward*
Post*
Thana*
State*
--SELECT--
Andaman and Nicobar (AN)
Andhra Pradesh (AP)
Arunachal Pradesh (AR)
Assam (AS)
Bihar (BR)
Chandigarh (CH)
Chhattisgarh (CG)
Dadra and Nagar Haveli (DN)
Daman and Diu (DD)
Delhi (DL)
Goa (GA)
Gujarat (GJ)
Haryana (HR)
Himachal Pradesh (HP)
Jammu and Kashmir (JK)
Jharkhand (JH)
Karnataka (KA)
Kerala (KL)
Lakshadweep (LD)
Madhya Pradesh (MP)
Maharashtra (MH)
Manipur (MN)
Meghalaya (ML)
Mizoram (MZ)
Odisha (OD)
Puducherry (PY)
Punjab (PB)
Rajasthan (RJ)
Sikkim (SK)
Tamil Nadu (TN)
Telangana (TS)
Tripura (TR)
Uttar Pradesh (UP)
Uttarakhand (UK)
West Bengal (WB)
District*
Pin Code*
PERMANENT ADDRESS
Same as Current address
Village/Mohalla*
Panchayat/Ward*
Post*
Thana*
State*
--SELECT--
Andaman and Nicobar (AN)
Andhra Pradesh (AP)
Arunachal Pradesh (AR)
Assam (AS)
Bihar (BR)
Chandigarh (CH)
Chhattisgarh (CG)
Dadra and Nagar Haveli (DN)
Daman and Diu (DD)
Delhi (DL)
Goa (GA)
Gujarat (GJ)
Haryana (HR)
Himachal Pradesh (HP)
Jammu and Kashmir (JK)
Jharkhand (JH)
Karnataka (KA)
Kerala (KL)
Lakshadweep (LD)
Madhya Pradesh (MP)
Maharashtra (MH)
Manipur (MN)
Meghalaya (ML)
Mizoram (MZ)
Odisha (OD)
Puducherry (PY)
Punjab (PB)
Rajasthan (RJ)
Sikkim (SK)
Tamil Nadu (TN)
Telangana (TS)
Tripura (TR)
Uttar Pradesh (UP)
Uttarakhand (UK)
West Bengal (WB)
District*
Pin Code*
EDUCATIONAL QUALIFICATION DETAILS
SL
1
2
3
4
5
Exam Name*
Matriculation*
Intermediate*
Graduation Pass Course
Graduation Hon's
Post Graduate
School/College Name*
Board/University Name*
Year Of Passing
Division/Grade
Full Marks
Obtained Marks
Percentage
6
Do you have NCC Certificate *
(Please Tick Here)
7
Do you have Sports Certificate*
--SELECT--
State Represent
Country Represent
SUBJECT GROUP
Subject Group *
--SELECT--
1. BHASHA - (HINDI / SANSKRIT / ARBI / FARSI / URDU)
2. BHASHA - (ENGLISH)
3. BHASHA - (TRIBAL / REGIONAL LANGUAGE)
4. SCIENCE - (PHYSICS / MATH)
5. SCIENCE - (CHEMISTRY / BIOLOGY)
6. SOCIAL STUDY - (HISTORY / GEOGRAUGHY / CIVICS / ECONOMICS / COMMERCE)
Subject Applied For*
(Make sure you have Qualified in this subject in
Intermediate
)
OTHER DETAILS
Please Select if you belong to the listed family * (Please Select if YES)
--SELECT--
N/A
SERVICEMAN / EX SERVICEMAN
MP / EX MP
MLA / EX MLA
EX COUNCILLOR
Are you specially abled
(Tick if yes)
and Select Type*
--SELECT--
Specially Abled Percent (%)
Select Teacher Training College*
--SELECT--
District Education and Training Institution Dayat, Jasidih
STUDENT DELCARATION
I hereby delcare that, all information mentioned in this form is true in best of my knowledge. During admission or training, if any of above delcated information found wrong, my candidature may be cancelled or expel from university. If any information or certificate may found false, i shall be punished and take action against me. I shall take admission in selected or recommended training college, and not claim for transfer to another place.
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