Form Fillup For Program Course
Wednesday, 9 Oct 2024
PERSONAL PART
Name
Date of Birth
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
*
Attach Your Passport Size Photo
Not more than 50kb
Nationality
-SELECT-
BANGLADESH
BHUTANESE
BUDDHIST
INDIAN
NEPALESE
THAI
TIBETAN
OTHERS
Religion
-SELECT-
HINDU
MUSLIM
BUDDHIST
CHRISTIAN
SIKH
JAIN
PERSIAN
OTHER
Minority
-SELECT-
YES
NO
Gender
-SELECT-
MALE
FEMALE
TRANSGENDER
Caste
-SELECT-
GENERAL
SC
ST
OBC-A
OBC-B
Physically Handicapped
NO
YES
Challenged Category
Cerebral Palsy
Hearing Impaired
Others
Physically Challenged
Visually Challenged
Blood Group
A+
B+
AB+
O+
A-
B-
AB-
O-
Mobile No.(10 Digit)
Email ID
Father's Name
Mother's Name
Gurdian's Qualification
No Literacy
Bellow Madhyamik
Madhyamik
HS
Graduate
Post Graduate
Guardian's Name
Guardian's Occupation
Monthly Family Income
Relation with Guardian
House No/Street
Ward No
Vill/Town
P.O.
Block
Police Station (P.S.)
District
State
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHHATTISGARH
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
PIN
Same as Present Address
House No/Street
Ward No
Vill/Town
P.O.
Block
Police Station (P.S.)
District
State
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHHATTISGARH
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
PIN
Marital Status
Unmarried
Married
Spouse Name
Economically Challenged Category
APL Card Holder
BPL Card Holder
General
Aadhar card No.
ACADEMIC PART
Qualifying Exam
MADHYAMIK / EQUIVALENT
Division
Select
First
Second
Third
Pass
Registration No.
M.P/Equivalent Roll
M.P/Equivalent No./Index No.
M.P Grade
Year of Passing
-Select-
2024
2023
2022
Name of the Board
West Bengal Board of Secondary Education
Migration
No
Yes
Name of the School
Statement of marks obtained in the M.P./Equivalent Examination
Please Select Subject
Marks Obtained
Full Marks Theory
English
Compulsoy
Bengali
Compulsory
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
Total Marks
Percentage
APPLICATION PART
Applicant may choose Elective Subject(s) as per his/her choice. But finally the said subject(s) will be offered to him/her on availability or eligibility at the time of admission.
Srl. No.
Stream
Elective 1
Elective 2
Elective 3
Group (A)
Group (B)
Additional
Merit Marks
1
-Select-
Arts
Science
Commerce
Bengali
English
-Select-
Sanskrit
Arabic
I have district or state level certificate for physical education
Please confirm Date of Birth then submit your Application Form.