Application Form Session:2021-2022
Application Add
* fields are mandatory
Course *
Name(As Per Matriculation)
*
Father's Name
*
Mother's Name
*
Guardian's name in case of orphan
Date Of Birth(As Per Matriculation)
*
DOB (In Words)
*
Age on 31st July(Current Year) *
Nationality
*
Other
Indian
Birth Place
*
District
State
Caste
*
--select--
General
OBC
SC
ST
Gender
*
Male
Female
Marital Status
Single
Married
Divorced
Spouse name if not divorced
Whether Physically Challenged
Yes
No
Visible identification marks
Occupation of Father & Mother/Guardian/Spouse(if married)
Parental Annual Income
Participation
NSS
Yes
No
NCC(A,B,C)
Yes
No
SPORT-(mention name)
Select Religion
*
--select--
Hindu
Muslim
Sikh
Christian
Other
Aadhar Card No.
*
Correspondance Address
Correspondance Address
Select State *
Andaman Nicobar(UT)
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Nepal
KOREA REPUBLIC OF
Select District *
City *
Police Station *
Pincode *
If Permanent Address same as Correspondance Address
Permanent Address
Permanent Address *
Select State *
Andaman Nicobar(UT)
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Nepal
KOREA REPUBLIC OF
Select District *
Anantapur
Chittoor
East Godavari
Anjaw
Changlang
Dibang Valley
East Kameng
East Siang
Kra Daadi
Kurung Kumey
Lohit
Longding
Lower Dibang Valley
Lower Subansiri
Namsai
Papum Pare
Siang
Tawang
Tirap
Upper Siang
Upper Subansiri
West Kameng
West Siang
Baksa
Dadra and Nagar Haveli
Daman
Barpeta
Diu
Bishwanath
Bongaigaon
Cachar
Charaideo[10]
Chirang[9]
Darrang
Dhemaji
Dhubri
Dibrugarh
Dima Hasao
Goalpara
Central Delhi
Golaghat
Hailakandi
Hojai[10]
Jorhat
Kamrup
Kamrup Metropolitan
Karbi Anglong
Karimganj
Kokrajhar
Lakhimpur
Majuli
Morigaon
Nagaon
Nalbari
Sivasagar
East Delhi
South Salmara-Mankachar
Sonitpur
New Delhi
Tinsukia
Udalguri
North Delhi
North East Delhi
West Karbi Anglong
North West Delhi
Shahdara
Araria
South Delhi
Arwal
Aurangabad
South East Delhi
Banka
Begusarai
Bhagalpur
South West Delhi
Bhojpur
West Delhi
Buxar
Darbhanga
East Champaran
Gaya
Gopalganj
Jamui
Jehanabad
Kaimur
Katihar
Khagaria
North Goa
Kishanganj
Lakhisarai
Madhepura
Madhubani
Munger
Muzaffarpur
Nalanda
Nawada
Patna
Purnia
Rohtas
South Goa
Saharsa
Samastipur
Saran
Sheikhpura
Sheohar
Sitamarhi
Siwan
Anantnag
Bandipora
Ahmedabad
Supaul
Amreli
Anand
Aravalli
Vaishali
West Champaran
Chandigarh
Banaskantha
Balod
Baloda Bazar
Balrampur
Bastar
Bemetara
Bijapur
Bilaspur
Dantewada
Dhamtari
Baramulla
Durg
Bhavnagar
Badgam
Gariaband
Janjgir-Champa
Doda
Jashpur
Ganderbal
Jammu
Kargil
Kabirdham (formerly Kawardha)
Kathua
Kanker
Kishtwar
Bharuch
Kulgam
Kondagaon
Botad
Kupwara
Korba
Leh
Koriya
Poonch
Mahasamund
Pulwama
Mungeli
Rajouri
Narayanpur
Ramban
Raigarh
Reasi
Raipur
Samba
Guntur
Rajnandgaon
Shopian
Sukma
Srinagar
Kadapa
Surajpur
Udhampur
Krishna
Surguja
Kurnool
Bokaro
Chhota Udaipur
Chatra
Deoghar
Dhanbad
Dahod
Dumka
East Singhbhum
Dang
Garhwa
Giridih
Godda
Prakasam
Gumla
Sri Potti Sriramulu Nellore
Hazaribag
Srikakulam
Visakhapatnam
Jamtara
Ahmednagar
Vizianagaram
Khunti
Akola
West Godavari
Koderma
Amravati
Latehar
Lohardaga
Aurangabad
Pakur
Beed
Palamu
Ramgarh
Bhandara
Ranchi
Amritsar
Buldhana
Sahibganj
Chandrapur
Barnala
Seraikela Kharsawan
Dhule
Simdega
Bathinda
West Singhbhum
Gadchiroli
Firozpur
Bagalkot
Ballari
Gondia
Faridkot
Belagavi
Hingoli
Bengaluru Rural
Fatehgarh Sahib
Bengaluru Urban
Jalgaon
Fazilka[12]
Bidar
Chamarajnagar
Gurdaspur
Chikkaballapur
Jalna
Hoshiarpur
Chikkamagaluru
Kolhapur
Latur
Jalandhar
Chitradurga
Mumbai City
Kapurthala
Dakshina Kannada
Mumbai suburban
Davanagere
Ludhiana
Dharwad
Dang
Nanded
Mansa
Gadag
Hassan
Moga
Nandurbar
Devbhoomi Dwarka
Haveri
Sri Muktsar Sahib
Nagpur
Kalaburagi
Pathankot
Kodagu
Nashik
Kolar
Patiala
Koppal
Osmanabad
Rupnagar
Mandya
Palghar
Sahibzada Ajit Singh Nagar
Gandhinagar
Mysuru
Sangrur
Raichur
Parbhani
Ramanagara
Pune
Shahid Bhagat Singh Nagar
Dang
Shivamogga
Tarn Taran
Devbhoomi Dwarka
Raigad
Tumakuru
Udupi
Ratnagiri
Gandhinagar
Ajmer
Uttara Kannada
Gir Somnath
Sangli
Vijayapura
Alwar
Satara
Bikaner
Yadgir
Sindhudurg
Barmer
Alappuzha
Ernakulam
Solapur
Banswara
Thane
Bharatpur
Idukki
Wardha
Baran
Kannur
Washim
Kasaragod
Bundi
Yavatmal
Kollam
Bhilwara
Kottayam
Churu
Bishnupur
Chittorgarh
Dausa
KottayamKozhikode
Churachandpur
Dholpur
Malappuram
Chandel
Palakkad
Dungarpur
Pathanamthitta
Jamnagar
Thrissur
Imphal East
Ganganagar
Junagadh
Thiruvananthapuram
Senapati
Kheda
Hanumangarh
Wayanad
Kutch
Tamenglong
Jhunjhunu
Lakshadweep
Thoubal
Mahisagar
Jalore
Agar Malwa
Jodhpur
Ukhrul
Alirajpur
Morbi
Jaipur
Anuppur
Narmada
Imphal West
Jaisalmer
Ashok Nagar
Jhalawar
East Garo Hills
Balaghat
Navsari
Karauli
Panchmahal
East Khasi Hills
Barwani
Patan
Kota
East Jaintia Hills
Betul
Porbandar
Nagaur
Bhind
North Garo Hills
Rajkot
Pali
Sabarkantha
Bhopal
Ri Bhoi
Surat
Pratapgarh
Burhanpur
South Garo Hills
Surendranagar
Rajsamand
Chhatarpur
Tapi
Chhindwara
Sikar
South West Garo Hills
Vadodara
Damoh
Valsad
Sawai Madhopur
Datia
South West Khasi Hills
Dewas
Sirohi
West Jaintia Hills
Dhar
Tonk
Dindori
West Garo Hills
Udaipur
Guna
West Khasi Hills
Gwalior
Harda
Hoshangabad
Indore
Aizawl
Jabalpur
East Sikkim
Champhai
Jhabua
North Sikkim
Kolasib
South Sikkim
Katni
Khandwa (East Nimar)
West Sikkim
Khargone (West Nimar)
Lawngtlai
Mandla
Lunglei
Mandsaur
Ariyalur
Mamit
Morena
Chennai
Saiha
Narsinghpur
Coimbatore
Serchhip
Neemuch
Cuddalore
Panna
Dharmapuri
Raisen
Dindigul
Rajgarh
Erode
Ratlam
Kanchipuram
Rewa
Kanyakumari
Sagar
Karur
Satna
Krishnagiri
Madurai
Sehore
Nagapattinam
Mehsana
Seoni
Nilgiris
Shahdol
Namakkal
Shajapur
Perambalur
Sheopur
Pudukkottai
Shivpuri
Ramanathapuram
Salem
Sidhi
Singrauli
Sivaganga
Tikamgarh
Tirupur
Ujjain
Tiruchirappalli
Umaria
Theni
Vidisha
Tirunelveli
Thanjavur
Thoothukudi
Tiruvallur
Tiruvarur
Tiruvannamalai
Vellore
Viluppuram
Virudhunagar
Ambala
Bhiwani
Charkhi Dadri
Faridabad
Fatehabad
Gurgaon
Hissar
Jhajjar
Jind
Kaithal
Karnal
Kurukshetra
Mahendragarh
Adilabad
Komaram Bheem Asifabad
Komaram Bheem Asifabad
Bhadradri Kothagudem
Hyderabad
Jagtial
Jangaon
Jayashankar Bhupalpally
Jogulamba Gadwal
Kamareddy
Karimnagar
Khammam
Mahabubabad
Mahbubnagar
Mancherial
Mewat
Medak
Medchal
Nalgonda
Nagarkurnool
Nirmal
Nizamabad
Peddapalli
Rajanna Sircilla
Ranga Reddy
Sangareddy
Siddipet
Suryapet
Vikarabad
Wanaparthy
Warangal (urban)
Warangal (rural)
Yadadri Bhuvanagiri
Dhalai
Gomati
Khowai[13]
North Tripura
Sepahijala[14]
South Tripura
Palwal
Unokoti[15]
Panchkula
West Tripura
Agra
Aligarh
Panipat
Allahabad
Rewari
Ambedkar Nagar
Amethi (Chhatrapati Shahuji Maharaj Nagar)[16]
Rohtak
Amroha (Jyotiba Phule Nagar)
Sirsa
Auraiya
Sonipat
Azamgarh
Bagpat
Bahraich
Ballia
Balrampur
Banda
Barabanki
Bareilly
Basti
Bijnor
Budaun
Bulandshahr
Yamuna Nagar
Chandauli
Bilaspur
Chamba
Hamirpur
Kangra
Kangra
Kinnaur
Kullu
Chitrakoot
Lahaul and Spiti
Deoria
Mandi
Etah
Shimla
Etawah
Sirmaur
Faizabad
Solan
Farrukhabad
Una
Fatehpur
Firozabad
Gautam Buddh Nagar
Ghaziabad
Ghazipur
Gonda
Gorakhpur
Hamirpur
Hapur (Panchsheel Nagar)
Hardoi
Hathras (Mahamaya Nagar)
Jalaun
Jaunpur
Jhansi
Kannauj
Kanpur Dehat (Ramabai Nagar)
Kanpur Nagar
Kasganj (Kanshi Ram Nagar)
Kaushambi
Kushinagar
Lakhimpur Kheri
Lalitpur
Lucknow
Maharajganj
Mahoba
Mainpuri
Mathura
Mau
Meerut
Mirzapur
Moradabad
Dimapur
Muzaffarnagar
Kiphire
Pilibhit
Kohima
Pratapgarh
Longleng
Raebareli
Mokokchung
Rampur
Mon
Saharanpur
Sambhal (Bheem Nagar)
Peren
Sant Kabir Nagar
Phek
Sant Ravidas Nagar
Tuensang
Shahjahanpur
Shamli
Wokha
Shravasti
Zunheboto
Siddharthnagar
Angul
Sitapur
Boudh (Bauda)
Sonbhadra
Bhadrak
Sultanpur
Balangir
Unnao
Bargarh (Baragarh)
Balasore
Varanasi
Cuttack
Debagarh (Deogarh)
Dhenkanal
Ganjam
Gajapati
Jharsuguda
Jajpur
Jagatsinghpur
Khordha
Khordha
Kendujhar (Keonjhar)
Kalahandi
Kandhamal
Koraput
Kendrapara
Malkangiri
Mayurbhanj
Alipurduar
Nabarangpur
Bankura
Nuapada
Bardhaman
Nayagarh
Birbhum
Puri
Almora
Cooch Behar
Rayagada
Sambalpur
Dakshin Dinajpur
Subarnapur (Sonepur)
Darjeeling
Sundargarh
Hooghly
Howrah
Bageshwar
Jalpaiguri
Karaikal
Kolkata
Maldah
Mahe
Murshidabad
Pondicherry
Yanam
Murshidabad
Chamoli
Nadia
North 24 Parganas
Champawat.
Paschim Medinipur
Purba Medinipur
Purulia
Dehradun.
South 24 Parganas
Haridwar
Uttar Dinajpur
Nainital
Pauri
Tehri Garhwal
ROPAR
Santokhgarh
Dhankutta
Kathmandu
Dhanusha
PITHORAGARH
Uttarkashi
Rudraprayag
Kakching
SAMSANDONG
Udham Singh Nagar
Andaman
South Andaman
Nicobar
North & Middle Andaman
City
Police Station
Pincode
Applicant Email
*
Landline No.
Applicant Mobile No.
*
Local Guardian name(if applicable)
Address
Relation
Mobile No.
E-mail
Name of Board/University of qualifying examination and also type(passed/result awaited)
*
Detail of repeat/supplementary Exam in qualifying Exam(if any)
Education Qualification: (Starting From 10th)
*
S.No
Education
Board/University
Passing Year
Total Mark
Grand Total
Marks(%)
Additional Achievements
S.No
Competition Name
Level
Position
Gap Year if Any
No
Yes
Have you ever been punished for any in disciplinary activity
Yes
No
High School Marks Sheet
Yes
No
High School Certificate
Yes
No
Intermediate Marks Sheet
Yes
No
Intermediate Certificate
Yes
No
Graduation Marks Sheets
Yes
No
Aadhaar Card
Yes
No
Caste Certificate
Yes
No
NSS/NCC/Sports Certificate (if any)
Yes
No
Character Certificate (if any)
Yes
No
Medical Certificate
Yes
No
Other Certificate If any
No
Yes
10th Marksheet (.jpg, .png only) & File size must be less than 1 MB
*
10th Certifiacte (.jpg, .png only) & File size must be less than 1 MB
*
12th Marksheet(.jpg, .png only) & File size must be less than 1 MB
*
*Please keep your duly filled application form with Payment Transaction /Reference Number for further references.
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