Form Fillup For Program Course
Sunday, 22 Dec 2024
PERSONAL PART
Name
*
Invalid Input
Date of Birth
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January
February
March
April
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June
July
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September
October
November
December
2010
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1950
*
Attach Your Passport Size Photo
Not more than 50kb
image size exceeds maximum allowable size
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
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Blood Group
A+
B+
AB+
O+
A-
B-
AB-
O-
Mobile No.(10 Digit)
*
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Email ID
Invalid Input
Father's Name
*
Invalid Input
Mother's Name
*
Invalid Input
Gurdian's Qualification
No Literacy
Bellow Madhyamik
Madhyamik
HS
Graduate
Post Graduate
Guardian's Name
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Guardian's Occupation
Monthly Family Income
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Relation with Guardian
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
Invalid Input
Same as Present Address
Permanent 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
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Marital Status
Unmarried
Married
Spouse Name
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Economically Challenged Category
APL Card Holder
BPL Card Holder
General
Aadhar card No.
Invalid Input
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
*
Invalid marks
Bengali
Compulsory
*
Invalid marks
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
*
Invalid marks
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
*
Invalid marks
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
*
Invalid marks
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
*
Invalid marks
-Select Subject-
Geography
History
Life Science
Mathematics
Physics
*
Invalid marks
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.