Student Application Form (Basic Details)

Title*

Name*

Gender

Male

Female

Other

Date Of Birth*

Aadhar No. of Applicant*

Email*

Mobile No.*

Qualification*

Stream*

Institution Name

Category (If Scholarship/Subsidy Applicable)

Sub Category (If OBC/OEC)

Economic Status (If Scholarship/Subsidy Applicable)

BPL

APL

Locality/Reference District*

Referral Organization (For applicants via Akshaya Centre Enrolment)

Center Name

Place and District

Center Code

Parent/Guardian Details (For applicants below 18 years)

Relationship

Father

Mother

Other

Name

Mobile Number

Communication Address

Country*

State*

District*

Constituency

Address Line1*

Address Line2

Address Line3

Pin Code*

Permanent Address

As Communication Address

Country*

State*

District*

Constituency

Address Line1*

Address Line2

Address Line3

Pin Code*

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Course, Center & Location

Mode (Online/Offline)

Course*

The for this course is INR

I declare that I have read and comprehended the course's eligibility requirements and that I believe I am qualified for this course.

I declare that I am aware that the course fee will not be reimbursed under any circumstances following the Commencement of the classes.

To the best of my knowledge and belief, I affirm that the information provided is accurate and correct. I declare that my candidature may be rejected at any moment if any of the above information proves to be fraudulent or wrong.