Bridge Course Registration Form

* indicates required field

Name of Student*

Age*

Date of Birth*

Name of Parent*

Address*

Pincode*

Mobile Number*

Occupation of Parent*

Professional
Government Service
Private Employment
Business
Others

Religion and Caste*

Whether belonging to BPL category*

Yes No

Whether belonging to*

Name of the School last studied*

Percentage of Marks obtained in the last qualifying exam*

Month and Year of passing*

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