COLLEGE CODE – 1106

For Enquiries : Tel. – 022 – 25852424 / Mob. – 98927 87534

Online Admission

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Online Admission

Photograph of Student *

Tick in any one category *

Inhouse
General

Signature of Student *

Name of the Student

Last Name - Student *

First Name - Student *

Middle Name - Student *

Father's / Husband's Name

Last Name - Father's / Husband's Name *

First Name - Father's / Husband's Name *

Middle Name - Father's / Husband's Name *

Mother's Name

Last Name - Mother's Name *

First Name - Mother's Name *

Middle Name - Mother's Name *

Date of Birth *

Gender :

Male
Female

Place of Birth *

Blood Group *

ADDRESS FOR CORRESPONDENCE *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

PERMANENT ADDRESS *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Mobile Number : (Parent) *

Mobile Number : (Student)

Email : *

Legal Reservation Information Section

If Reserved : SC/ST/OBC/DT(A)/NT(B)/ NT(C)/ NT (D)/ SBC

Domicile of State: *

Category : Open
Category : Reserved

Physically Handicapped

Yes
No

Educational Details

STD 10th

Name of Board / University *

Name of School or College *

Exam Seat No. *

Date of Passing Exam ( Month & Year) *

Passing Certificate No. *

Grade or Total Marks & out of *

STD 12th

Name of Board / University

Name of School or College

Exam Seat No.

Date of Passing Exam ( Month & Year)

Passing Certificate No.

Grade or Total Marks & out of