Admission Form

Educational Technology Center for Visually Challanged

Name of the student:
Current address:
Permanent address:
Phone number:
Alternate phone number:
Mobile number:
Email ID:
Alternate Email ID:
Personal Details:
Date of birth:	Month Date Year
Gender:	Male Female
Nationality:	Indian Foreigner
Languages Known:
Family details:
Parent or guardians name
Occupation of parent or guardian:
Students or parents annual income:
Siblings:
Acadamic details:	SSC
Name of institue or School:
Board or examining body:
Marks obtain in percentage
Year of passing:
Acadamic details:	HSC
Name of institue or school:
Board or examining body:
Marks obtain in percentage
Year of passing:
Acadamic details:	Graduation
Name of institue or college:
University or examining body:
Marks obtain in percentage
Year of passing:
Acadamic details:	Post Graduation
Name of institue or college:
University or examining body:
Marks obtain in percentage
Year of passing:
Acadamic details:	Doctoral Education
Name of institue or college:
University or examining body:
Marks obtain in percentage
Year of passing:
Any other qualification
Current institution/school/college
Name of course
Year or semister
Genral information:
Specify your carrer objective
Do you know Braille	YesNo
Specify your computer knowledge in detail
For which course or scheme you want to enroll

Today's Date:Month Date Year I here by declare that all the information furnished above is correct to best of my knowledge and belief.