STUDENT NAME

EMAIL ID

MOBILE NO

SELECT DEGREE B.DES BBA B.TECH B.Sc Finance MBA MBA-DMST M.Des Design Summer School Management Summer School Tech Summer School DEGREE

SELECT STATE Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra & Nagar Haveli Daman Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamilnadu Tripura Uttar Pradesh Uttarakhand West Bengal Telangana Diu STATE

SELECT CITY CITY

SCHOOL/COLLEGE NAME

SELECT GRADE 8th 9th 10th 11th 12th First Year Second Year Third Year Grade

SELECT HOSTEL TOUR REQUIRE YES NO HOSTEL TOUR REQUIRE