Name of the Student (in block letters) **Date of Birth **Nationality **Religion **GENDER:*MALEFEMALEName of the School (Last Attended) **Medium of Instruction **Father’s Name **Mother’s Name **Whether affiliated to (CBSE / ICSE / or any other **Academic Qualifications **Occupation **Name of the Organization **Office Address **Telephone No. (Office)Permanent Residential Address **Tel.no. (Residential)Mobile No. **Please tick on any one of the Stream and combination of subjects you would opt for **Please selectMaths/English/Physics/Chemistry/BiologyMaths/English/Physics/Chemistry/ComputerMaths/English/Physics/Chemistry/ ( Informatics Practices/Physical Educatation ) English/Accountancy/Economics/Business Studies ( Maths/Informatics Practices/Physical Educatation )Parent/Guardian Name **Submission Date **Student Photo*SendThis field should be left blank
