Name in Full (in BLOCK letters):

Gender:
MaleFemaleOther

Date of Birth:

Father’s Name:

Father's Occupation:

Mother’s Name:

Mother's Occupation:

Annual Income:

Category:
BPLAPL

Nationality:

Religion:

Caste:

State where permanently settled:

District:

Full Address:

Stream studied in +2:
+2 Science+2 Commerce+2 Humanities+2 VocationalOther

Percentage of Marks Acquired:

Studied School Name:

Preferred State to Study:
Andhra PradeshTamil NaduKarnataka

Course you want to join:
GNMBSc NursingBSc MITBSc MLTAT & OTBPTOthers

Student Contact Number:

Guardian Contact Number:

Referred By: