Task 3 - Student Registration Form
Personal Information
First Name:
Last Name:
Father's Name:
Mother's Name:
Date of Birth:
Email:
Phone Number:
Father's Phone No.:
Gender:
Male
Female
Other
Physical Disability :
Yes
No
Income (>2.5Lac) :
Yes
No
Btech Mode :
Regular
Distance
Aadhaar Number :
Category :
Select
SC
ST
General
OBC
EWS
Educational Background
10th Grade School:
10th Grade Year of Passing:
10th Grade Marks (%):
12th Grade School:
12th Grade Year of Passing:
12th Grade Marks (%):
Diploma Institution:
Diploma Year of Passing:
Diploma Marks (%):
Course Preference
B.Tech Branch Preference:
Select Branch
Computer Science Engineering
Electronics and Communication Engineering
Electrical and Electronics Engineering
Mechanical Engineering
Civil Engineering
Information Technology
Mode of Study:
Regular
Distance
Preferred Class Timings:
Morning
Afternoon
Evening
Additional Information
Address:
City:
State:
Zip Code:
How did you hear about us?
Select
Online Advertisement
Friend/Family
School/College
Educational Event
Additional Comments: