MISPACK
Online Admission Form for - PRATIBHA JUNIOR COLLEGE


Student Details :
Was your previous education from same institute (school/college) ? Yes No
Admission Year* Application for Class*
Prefix* Last Name* First Name* Father Name* Mother Name* Grandfather Name*
Permanent Address* Present Address Same as Permanent*
City* Taluka* District* Pin Code(ZIP)* State* Country*
Gender* Date of Birth* Birth Date in Words* Place of Birth* Age*
Category* Religion* Caste*select other if not found Sub Caste Handicap?* Blind?* Minority?* NRI?*
Yes No Yes No Yes No Yes No
Mother Tongue* Care Taken* Passport No. Aadhar Card No.* Blood Group* Home to KM from residence*
SMS Contact* Other Contact* Email*

Previous School / College Detail :*
School / College Name* Board / University* Reason of Leaving*

Qualification :
Exam    (HSC/SSC) Year of Passing Seat No. Board Mark Percentage School

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