Distance Education

Application Form

Course :

Student Name :

Father's Name :

Mother's Name :

Date Of Birth :

Gender :

Blood Group :

Contact Number :

Email Id :

Permanent Address :

City :

State :

Pincode :

Parent Contact Number :

Parent Occupation :

Annual Income :

Community :

Nationality :

Guardian Name :

Guardian Address :

S.No	Examination Passed	Name of Board	Year	Marks Obtained	Percentage
High School
10+2/ITI/Dip
Graduation
Post Graduation
M.Phil.

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