APARK

INSTITUTE OF EMPLOYMENT EDUCATION AND RESEARCH

15, Vivekananda Colony, Balwant Nagar, Gandhi Road, Gwalior M.P.

 

 

ADMISSION FORM

 

NAME OF THE STUDENT-------------------------------------------------------------------------------------------------------------------------------------------

 

 

            FATHER’S NAME-------------------------------------------------------------------------------------------------------------------------------------------------------

 

                                                            MOTHER’S NAME------------------------------------------------------------------------------------------------------------------------------------------------------

 

                                                            DATE OF BIRTH---------------------------------------------------------------------------------------------------------------------------------------------------------

 

                                                            SEX-------------------------------------------------(Male/Female)     NATIONALITY----------------------------------CASTE-------------------------------

 

                                                            POSTAL ADDRESS----------------------------------------------------------------------------------------------------------------------------------------------------

                                                                                       

                                                                                         ----------------------------------------------------------------------------------------------------------------------------------------------------

 

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                                                            CONTACT NO. (TELEPHONE WITH STD CODE)-----------------------------------------------------------------(MOBILE)--------------------------------------

 

                                                            COURSE APPLYING---------------------------------------------------------------------STREAM----------------------------------------------------------------

 

                                                            MEDIUM-------------------------------------------------(HINDI/ENGLISH )

 

                                                            EDUCATIONAL QUALIFICATION---------------------------------------------------------------------------------------------------------------------------------

                                                            (From 10th standard onwards)

                                                                                                          -----------------------------------------------------------------------------------------------------------------------------------

                                                                                                   

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                                                            Mode of payment:  By DD / At par Cheque  [---------------------------------------------------------------------------------------]

                                                                                                                                                                                    Bank Name and City 

                                                                                           

                                                                                                                             [---------------------------------------------------------------------------------------]

                                                                                                                                                                        Amount and DD/At par Cheque No.

                                                            EMAIL: -----------------------------------------------------------------------------------------------------------------------

                                                           

                                                            FAX (if any)-----------------------------------------------------------------------------------------------------------------

 

                                                            I, here, by declare that the above information given by me is completely correct to the best of my knowledge.

                                                            In case of finding any false statement I shall always be responsible and institute may take any legal action against me.

                                                           

                                                           Student has to enclosed the Photocopy of 10th , 12th , Graduation, and Post graduation (For M.Phil) certificates

                                                           and Four photographs with this form.

                                  

                

                                                           Signature of the Student------------------------------------------

 

 

                                                           Parents/Guardians signature -----------------------------------

 

                                                           Date and Place -----------------------------------------------------