Registration Form

Basic Details

Enrollment Date

Please enter valid enrollment date.

Full Name

Email Address

Phone

Unique Id Proof

Date of Birth

Unique Id Proof Number

Gender

Address

Current Address

City

State

PIN Code

Education Qualifications

Institution Type

Institution Name

Institution Address

Institution City

Institution Pincode

Please enter valid pincode.

Institution State

Year of passing out

Family Details

Annual Family Income (Per Annum)

Please select Annual Family Income.

No of Family members (including you)

Guardian’s Full Name

Guardian’s Mobile(digits only)

Relationship with guardian

Declaration

All the information above is true to my knowledge. Any deviation from the information submitted can lead to my disqualification from the program

I disclose the information willingly for it to be used by the authorities for the purpose of the program. Also, the authorities have the right to use the pictures, videos and above-mentioned details for media surveys.

I will adhere to guidelines and complete the program.