STUDENT REGISTRATION FORM
Office Use
Student Registration No
:
Registration Date
:
Course
:
--Select Course--
Mathematics & Science
Mechanical Engineering
Electrical Engineering
Electronics and Telecommunication Engineering
Civil Engineering
Student Details
Student FirstName
:
Student MiddleName
:
Student LastName
:
Date of Birth
:
Gender
:
Male
Female
Email
:
Category
:
~SelectCategory~
General
Obc
Sc/St
Nationality
:
Religion
:
Mother Tounge
:
~Select MotherTongue~
Hindhi
Odiya
Telgu
English
Urdu
Bengli
Blood Group
:
Select Blood Group
O+ve
O-Ve
A+ve
A-Ve
B+Ve
B-ve
AB-Ve
AB+Ve
Mobile No
:
Parent Details
Father's Name
:
Mother's Name
:
Father's Qualification
:
Mother's Qualification
:
Father's Occupation
:
Mother's Occupation
:
Father's Phone No
:
Mother's Phone No
:
Father's Annual Income
:
Mother's Annual Income
:
Present Address
At
:
Po
:
Dist
:
Police Station
:
Pin
:
State
:
Permanent Address
Same as Present Address
At
:
Po
:
Dist
:
Police Station
:
Pin
:
State
:
I hereby confirm and declare that all information given here in true & correct and I shall accept all the terms and condition as started. I shall be bound and abide with the rules and regulations of organization.