::Exam Information::
Select campus in which you want to get the admission :*	Select Campus BHOPAL CAMPUS
Course Level*		Course name :*	Select Course name

::General Information::
Candidate's First Name (As per 10+2 Marksheet):*		Last Name/SurName:*	Last Name/Surname नहीं होने पर "NA" का प्रयोग करें
Gender*	-Select- Male Female Transgender	Date of Birth(DD/MM/YYYY):*
Category *	-Select- UR OBC SC ST EWS	Father's Name:*
Domicile of Madhya Pradesh*	-Select- Yes No	If Other then MP then select State                                          Select Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep Pondicherry Other Telangana Ladakh
Sub Category:	-None- Handicapped J&K Migrants Army Quota (Self)	Student belongs to *	--Select-- RURAL URBAN

::Address::

House No/Village:* Colony/Post office:*   City/Tehsil:* District:*   State:* Select Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep Pondicherry Other Telangana Ladakh Pincode:*

::Other Details::
Phone Number(Off./Resi.)(With STD Code)	Mobile Number*	. Email Id *
	**Do not use Prefix '0' or '+91' In mobile Number

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कृपया फोटो के साथ सिग्नेचर भी अटैच करें सिग्नेचर के अभाव मैं आपका फॉर्म निरस्त किया जा सकता है इसकी ज़िम्मेदारी स्वयं आपकी होगी

::Checklist for Enclosures(To be produced at the time of Counseling)::
Domicile Certificate (if from MP)	EWS/Caste Certificate	In Service Documents of Army/Handicapt/J&K Migrants certificate	High School (10th) marksheet *
All Diploma Marksheet *	10+2 marksheet or Equivalent *	Graduation Marksheet *	All Post Graduation Marksheet *
For MCA Please Tick Mathmatics as a Subject at      10+2 Level                               Graduation Level

Declaration

I hereby declare that the information given in this application is true and correct to the best of my knowledge and belief. In case any information given in this application proves to be false or incorrect, I shall be responsible for the consequences.

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