First Name

Middle Name

Last Name

Date of Birth

Gender

Father's Name

Mother's Name

Permanent Address

Village

Town

State -Select- Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura

District -Select-

Pin Code

Temporary Address

Pin Code

Marital Status Married UnMarried Widow

Religion Hinduism Islam Christianity Sikhism Buddhism Jainism Zoroastrianism Judaism

Name of School/College last Attended

Class

Year

Division

Total Marks

Secured Marks

Percentage

Subjects

Subject offered:

Honours in -Select- English Khasi Education History Political Science Economics (B.A.) Sociology

Elective Subject (Please refer prospectus)

Contact Number

Email ID

Blood Group A positive (A+) A negative (A-) B positive (B+) B negative (B-) O positive (O+) O negative (O-) AB positive (AB+) AB negative (AB-)

Date

Shift Morning Day