STUDENT REGISTRATION FORM
Basic Information
Full Name
First Name
Middle Name
Last Name
Student Number
Ex:01
Year Level
Plaese Select
2023
2022
2021
2020
2019
2018
Ex:2018
Degree Program
Please Select
DIPLOMA
BE
ME
BCA
MCA
Email
Phone Number
Network Provider
Plaese Select
Airtel
Bsnl
Jio
Vodafone
Idea
Ex:2018
Birth Date
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
Year
Permanent Address
Address Line 1
Address Line 2
City
State/Province
Postel / Zip Code
United States
India
Singapore
Country
Emergency Contact
First Name
Last Name
Relationship
Ex: Father, Mother, etc
Address Of Person To Contact In Case Of Emergency
Address Line 1
Address Line 2
City
State/Province
Postel / Zip Code
Phone Number Of Person To Contact In Case Of Emergency
Plaese enter a valid phone number
Other Extra Caricular Activities
Extra Caricular Participants
Student Council
Cricket
Others
Cash Officer
Shop-keeper
Other Details
Resources Available
Mobile
Printer
Laptop
Television
LCD Projector
Skills/Talents
Acting
Creativity
Teamwork
Design
Leadership
Writing
Negotiation
Problem solving
Active listening
Critical thinking
Marketing
Speaking
Math
Painting
Networking
Storytelling
Sports
Basketball
Boxing
Cricket
Hockey
Skateboarding
Skiing
Bowling
Archery
Golf
Tennis
Baseball
Swimming
Football
australian football
Interests
Estimate Your Family Monthly Income
Please Select
25000
35000
50000
75000
100000
Do You Have Any Scholarship
Yes
No
Who/What is the name of your sponsor?
Do You Plan To Switch To Another Course?
Yes
No
What Course Is Your First Choice Is The Univercity?
What Is Your Plan After Collage?
Please Select
Job
Business
Sports
Suggestions / Comments
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