Registration Form : Advanced Technology Blind Student's Learning Centre

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Admission form

* 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: 1
2

Family details:

* Parent or guardians name

* Occupation of parent or guardian:

* Students or parents annual income:

* Siblings:

Academic details:
SSC

* Name of institute or School:

* Board or examining body:

* Marks obtained in percentage

* Year of passing:

Academic details:
HSC

* Name of institute or school:

* Board or examining body:

* Marks obtained in percentage

* Year of passing:

Academic details:
Graduation

Name of institute or college:

University or examining body:

Marks obtained in percentage

Year of passing:

Academic details:
Post Graduation

Name of institue or college:

University or examining body:

Marks obtained in percentage

Year of passing:

Academic details:
Doctoral Education

Name of institue or college:

University or examining body:

Marks obtained in percentage

Year of passing:

Current qualification:

Current institution/school/college

Name of course

Year or semister

GenEral information:

* Specify your career objective

* Do you know Braille?
Yes No

* Specify your computer knowledge in detail

* For which course or scheme you want to enroll

I here by declare that all the information furnished above is correct to best of my knowledge and belief.