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Technology Enabled (Distant) Learning Programs

   
Programme / Course applied for: *
   
Personal Details
   
Name of Candidate:*
(As recorded in the School Leaving Certificate.) A) Block letters
Gender: * Male   Female
Date of Birth: *
Aadhaar Card No :
Place of Birth : *
Village :
Taluk :
District : *
State : *
Nationality : *
Mother tongue :
Religion with sub sect :
Caste :
Category :
Physically disabled : Yes   No
Name of Father : *
Name of Mother :
   
Permanent Address :
   
House No/House Name : *
Land Mark :
Post office : *
Town/City : *
Pin : *
Address for communication : Same as permanent address
House No/House Name : *
Land Mark :
Post office : *
Town/City : *
Pin : *
Telephone number (with STD code) :
Mobile number : *
E-mail : *
Confirm E-mail : *
   
Educational qualifications ( From Matriculation onwards) *
 
Name of Degree/ Course Board/University Year of passing Percentage of Mark Delete
 
Fees : Rs  500 /-
Payment Details Online    Demand Draft
Upload Photo : *
Your photograph in digital form with following specification. Maximum Size : 30Kb, Image Dimension : 150W X 200H px, Image Type : JPG
Upload Signature : *
Scanned image of your signature put on a good quality white paper with blue/black ink. Maximum Size : 30Kb, Image Dimension : 250W x 90H px, Image Type : JPG
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* Enter the string as seen in the image above
     
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