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Only students appeared in current year High School Examination need to apply
Select Target Course
*
Select
IIT (JEE)
NEET (PMT)
*Required
Registration Date
*
*Required
*Enter Correct Formet (dd-MMM-yyyy)
1. Name
*
*Required
*Only Characters Allowed
*Only Characters Allowed
*Only Characters Allowed
2. Date of Birth
*
*Required
*Enter Correct Formet (dd-MMM-yyyy)
3. Father's Name
*
*Required
*Only Characters Allowed
*Only Characters Allowed
*Only Characters Allowed
4. Mother's Name
*
*Required
*Only Characters Allowed
*Only Characters Allowed
*Only Characters Allowed
5. Gender
*
Select
Male
Female
Other
*Required
6. Contact Number
*
*Required
*Invalid Mobile Number
*Invalid Mobile Number
7. Email Address
*
*Required
Invalid Email Format
8. Select State
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Select
Uttar Pradesh
Andaman & Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Pondicherry
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttarakhand
West Bengal
Jharkhand
Punjab
New Delhi
Telangana
*Required
9. Permanent Address
*
9(a)District
*
*Required
9(b)Village/Mohalla/Tola
*
*Required
9(c)Post/Town
*
*Required
10. Annual Family Income (From all sources)
*
*Required
11. Number Of Sibling(s)
*
12.(a) High School Subject & Marks
*
Maths & Science %
Marks Obtained (प्राप्तांक)
Total Marks(पूर्णांक)
Total %
*Required
17. Other Certificate(Extra Curricular Activity)
13. Reference By Two Respected Persons Of The Society:
Name
Designation
Mobile
*Invalid Mobile Number
Upload Letter
Name
Designation
Mobile
*Invalid Mobile Number
Upload Letter
14. Student Photo
*
*Required
Decleration by Parent
I do hereby declare that all the information furnished above is true and in case any information is found to be false at any stage, the candidature/admission may be cancelled.
I do hereby declare that I have read & understood the important instruction regarding filling the form & eligbility.
District/Place
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Date:
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*Enter Correct Formet (dd-MMM-yyyy)
Upload Signature
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Helpline Number:- +91 - 9140859796,9628330347,8887683635,9451228804,9140020155 & 9450494747
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