Site Name

* marked fields are mandatory

1. Name of the Candidate *
2. Name of the Father *
3. Name of the Mother *
4. Gender * 5. Date of Birth *
6. Area in which candidate Resides * 7. Religious
Caste Category * Disability Status of the Candidate *
Postal Address for Correspondence
A. At * B. PO *
C. District * D. Block *
E. PIN *
Name and Adress of the Institution in which studying at Class   level
A. School District * B. School Block *
C. School Name *
D. School Address *
E. Pin
Type of Institution/School in which studying at Class level * Area in which School is Located *
At National Level  * (a) Medium of Examination (b). Language Subject
Family Details
Father's Education * Father's Occupation *
Mother's Education * Mother's Occupation *
No. of family members living in the house *
No. of Brothers * No. of Sisters *
22. Percentage of Mark Secured at Class IX Annual Exam  * (if mark in cgpa convert to percentage)
At what number is the candidate among his/her brothers and sisters *
Parental Annual Income
(Proof to be attached) *
Contact Details
A. Telephone B. Mobile No
C. E-Mail ID (If you do not have email id, provide school's/HM's email address)
Enter Image Code  *