College And Course Details
District*	-- Select -- 1 - ASHOKNAGAR 2 - BHIND 3 - DATIA 4 - GUNA 5 - GWALIOR 6 - MORENA 7 - SHEOPUR 8 - SHIVPURI
College Name*
Program Name*		Select Branch*	-Please Select-
Year*	-Please Select- 1YEAR
Admission Type*	DISTANCE	Medium*	-Please Select- ENGLISH HINDI

Personal Details
First Name		Last Name
Name in Hindi*	* Convert Hindi text Click here
DOB*		Gender*	-SELECT- Male Female   Domicile*   -SELECT- YES NO
Father's Name*		Mother's Name*
Marital Status*	MARRIED UNMARRIED WIDOW SELECT	Husband's Name
Category*	-SELECT- UR OBC SC ST
Sub-Category	Minority  Handicapped Freedom Fighter Employee Ward (Only for Jiwaji University Employees) Blind Prisoners of Central Jail,Gwalior M.P.
Nationality*	-SELECT- INDIAN OTHER	Religion*	-SELECT- HINDU MUSLIM SIKH CHRISTIAN JAIN

Address

Correspondance * * * -----Select----- Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra & Nagar Haveli Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil Nadu Telagana Tripura Uttar Pradesh Uttarakhand Uttaranchal West Bengal * * * Copy to Permanent Address

Permanent * * * -----Select----- Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra & Nagar Haveli Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil Nadu Telagana Tripura Uttar Pradesh Uttarakhand Uttaranchal West Bengal * * *

Other Details
Phone Number(With STD Code)		Mobile Number*
Email Id*

Previous Education Details
Exam Passed*	-SELECT- HSSC(12th) GRADUATE POST-GRADUATE UG-3YEAR PG-3YEAR
University/Board*	Enter Board or Univ. Name : Jiwaji Enroll No : (Don't enter /,-, etc between enroll no.)
Passing Year*	1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 -Please Select-	Percentage*	.  %
Eligibility/Migration/Transfer Certificate No.*		JIwaji Univ Previous Roll No(For Ex)

Enclosures Eligibility certificate? Migration certificate? Proof for DOB? Marksheet? Gap Certificate? Photo & Signature Upload Image

Declaration
I hereby declare that the information filled by me is true and complete as per my knowledge. If any information provided by me is found false or incorrect then i shall be disqualified by the university.