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

 

                                                            CONTACT NO. -----------------------------------------------------------------(TELEPHONE)-----------------------------------------------------------------------------------(MOBILE)

 

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

 

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

 

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

                                                            (From 10th standard onwards)

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

                                                                                                         

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

 

                                                           EMPLOYMEE DETAIL (If any)   a. Designation --------------------------------------------------------------------------------------------------------------------------------------------

 

                                                                                                          b. Name of the company/institution---------------------------------------------------------------------------------------------------------------

                                              

                                                                                                          c. Address of the company/institution-----------------------------------------------------------------------------------------------------------

 

 

                                                                                                          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 best to my knowledge. In case of finding any false statement I shall always

                                                            be responsible and institute may take any 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 -----------------------------------------------------

 

                                                           

 

 

 

 

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