Application Form

Name*
(as per SSLC certificate)

Aadhaar Card No.*

Date of Birth*
(as per SSLC Certificate)

Gender

Mother Tongue*

Qualification*

Passed Out year*

Marks Obtained / Grade*

Medium of Study*

Languages known

Tamil Malayalam Kannada Telugu Hindi English Others

Religion*

Community*

Father’s Name*

Occupation*

Mother’s Name*

Occupation

Father’s Contact No*

Mother’s Contact No

Primary Student Contact Mobile No*

Email ID*

Communication Address*
House No, Street

State*

Pin code

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