REGISTRATION FORM (JULY-2024)
(A). Programme Details /कार्यक्रम का विवरण
Regional Center Name / क्षेत्रीय केंद्र का नाम   *
Study Center Name / अध्ययन केंद्र का नाम   *
Course Type / कोर्स का प्रकार   *
Name of Programme / कार्यक्रम का नाम   *
Progarm Year (कार्यक्रम वर्ष)   *
Course Fees

Eligibility ()

Nature of Programme / कार्यक्रम की प्रकृति   *
Medium For SLM/ माध्यम   *
Do you need study or learning material? / क्या आपको अध्ययन या शिक्षण सामग्री की आवश्यकता है?   *
(B). Compulsory Core Course / विषय केन्द्रित अनिवार्य पाठ्यक्रम
(C). Personal Details / व्यक्तिगत विवरण
Student Name / अभ्यर्थी का नाम (in English)   *
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Student Name / अभ्यर्थी का नाम (हिन्दी में)   *
Father's Name / पिता का नाम (in English)   *
Father's Name / पिता का नाम (हिन्दी में)   *
Mother's Name / माता का नाम (in English)   *
Mother's Name / माता का नाम (हिन्दी में)   *
Date of Birth / जन्म तिथि   *
Aadhar No. / आधार नंबर  *
ABC ID   * ABC PORTAL LINK
Email id / ईमेल आईडी   *
Category / श्रेणी   *
Student Under Dependent / Defence & security services / आश्रित रक्षा और सुरक्षा सेवाओं के तहत छात्र
Gender / लिंग   *
Is Physically Challenged If yes Mention Category /   *
दिव्यांग है तो हाँ चुने और श्रेणी उल्लेख करें

Blood Group / ब्लड ग्रुप  
Religion / धर्म   *
Territory / क्षेत्र   *
Nationality / राष्ट्रीयता   *
Mobile Number / मोबाइल नंबर   *
Permanent Address (Including Pin Code) /   *
स्थायी पता (पिन कोड सहित)
State / राज्य   : District / जिला   : Pin Code  :
 (Tick If The Corresponding Address Is same as the Permanent Address)
Mailing Address (Including Pin Code) /   *
पत्र व्यवहार का पता (पिन कोड सहित)
State / राज्य   : District / जिला   : Pin Code  :
Are you employed? / क्या आपके पास रोज़गार है?   *
(D). Educational Qualification / शैक्षिक योग्यता
Name of Examination / परीक्षा का नाम Board / University / बोर्ड / विश्वविद्यालय Document Year / वर्ष Subject / विषय Marks / अंक
Max Obtained
Percentage / प्रतिशत Division / श्रेणी
High School or Equivalent /
हाई स्कूल या समकक्ष   *

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Intermediate / इंटरमीडिएट   *
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Under Graduation / स्नातक Text Box:(Within the Box);
Post Graduation / स्नातकोत्तर Text Box:(Within the Box);
Others / अन्य Text Box:(Within the Box);

Personal Declaration :- "I do hereby declare that all the statements made in the application are true, complete and correct to the best of my knowledge and belief. I am duly aware that in the event of any particulars or information furnished by me is found to be false/incorrect/incomplete or if I am found indulging in some unlawful act at any time during the course period, my candidature is liable to be summarily rejected/cancelled."Additionally undertaking for students whose results are awaited: "I, having been permitted to be provisionally admitted to University hereby undertake to produce the proof of having successfully qualified in the final qualifying examination with requisite percentage of marks if failing, I shall forthwith vacate the seat and shall have no claim for refund of fees already paid."

2. Anti Ragging Declaration

I, owing allegiance to the University, declare that I shall abide by all the rules while studying in the University/College/Study Centre and shall not indulge in any kind of ragging related activities. In doing so, the University will be free to take constitutional action against me & I also declare to submit Anti Ragging declaration form available at https://www.antiragging.in!

3. Anti Drug Declaration

i. I am aware that the possession, use, sale and distribution of alcohol/tobacco/any psychoactive substances are wrong and harmful.
ii. I shall refrain from using, being under the influence of, possessing, furnishing, distributing, selling or conspiring to sell or possess, or being in the chain of sale or distribution of alcohol/tobacco/any psychoactive substances within the premises of the institute/university or during any sponsored activities by the institute/university.
iii. I shall report to the authorities of the institution any irregular behaviour that I observe in relation to the possession, use, sale and distribution of alcohol/tobacco/any psychoactive substances which may have occurred at the institution or during any activities conducted by any students or institution.
iv. I shall support and actively participate in any substance use prevention education programmes which may be organized by the institution/government which would enable me to be a better student and citizen of India. v. I shall co-operate with the authorities of the institution and other relevant authorities in their investigation of any substance-related Incident of which I may have information, and to prevent the possession, use, sale and distribution of any psychoactive substances in or around my Institution.