Application form for Entrance  Test 2019-20
Course Type*:
 
Select Online Entrance Test Center * :
Select Courses on Priority Base*(One or more courses)
Course Preference 1.
Course Preference 2.
Course Preference 3.
Course Preference 4.
Course Preference 5.
Applicant's General Details
Full Name (English)* Full Name (Hindi)*
Father's / Husband's Name (English)* Father's / Husband's Name (Hindi)*
Mother's Name (English)* Mother's Name (Hindi)*
Date of Birth* (dd/mm/yyyy) Gender*
Email Id * Driving Licence No./Voter ID No./Passport No./
Samgra Id No./Last Exam Pass Roll No.
(Anyone of the above) *
Nationality* Whether domicile of Madhya Pradesh* :  
Blood Group* Do You Have any ATKT Pending 1st to 5th semester*  
Correspondance Address
Address. 1 Address. 2
District Phone No. (With STD Code) -
Permanent Address*
Address. 1 Address. 2
District Phone No. -
Mobile.No.   (Do not prefix 91 or 0 Zero ) 
Other Details
240 hrs participation in NSS activities at University level or B/C Certificate
NCC "C" Certificate  
Cultural activities at Inter-University level/National level
Sports activities at Inter-University level/National level
Option for Admission on
* Category *
Sub-Category
Teachers/Officers staff ward class 3 or 4       PHY Handicapped      Freedom Fighter   Nishakatjan 
 Kashmiri Migrant     NRI   None 
Have you passed Hon's course?
Graduate From:
Whether Candidate is Employee or Not
Qualifying Exam Details
Passing Year Qualifying Exam Percentage(%) Roll No. Name of University/Board Result Awaited?

Have you ever been expelled/rusticated from any educational institution or convicted by a court of law?.  
Particulars of Guardian
(a) Full Name (b) Occupation (c) Annual Income (per annum)  
Attachment (Note : Attachment should be .jpg format and size<200 KB)
10th class Certificate
12th class Certificate
UG Certificate
Only for Pg and MPhil Course.
Photo Signature