* mark fields are mandatory.

Programme *
Departments *
First Name *
Middle Name
Last Name
JEE Main/OJEE/Univ. Entrance Roll Number *
JEE Main/OJEE/Univ. Merit List Rank *
Academic Session *
Entrance Exam
Date of Birth *
Gender *
Category *
Nationality *
Religion *
Blood Group *
TFW * [?]
Mode *
PWD *
Defence *
Green Card *
Father's Name *
Mother's Name *
Candidate’s Mobile No. *
Email ID *
Parent’s / Guardian’s Mobile No. *
Parent’s / Guardian’s Email ID
Present Address *
Permanent Address * Same as Address for Correspondance
Qualification (Applicant should manually fill up his/her percentage of mark if marks awarded in CGPA.)
Name of Examination Name of School/College Name of Board Total Marks/CGPA Marks Secured/CGPA Percentage Year of Passing
10th *
12th / Diploma *
B. Tech. / B. Arch. / B. Sc.
M. Tech. / M. Sc. / MCA / M. Phil.
Signature * [?]
Security Text *