D.El.ed Registration Form

(1) Please fill up the form in English block letters.
(2) Tick the appropriate box.
(3) All information are mandatory except Sl. 23

Student Image *

Click or drag a file to this area to upload.

Student Image

1. College Code

2. College Name *

3. Student's Name *

4. Student's Name in Hindi

5. Mother's Name *

Mother's Name in Hindi

6. Father's Name *

Father's Name in Hindi

7. Date of Birth//

(DD/MM/YYYY) (As per Matric/Class X)

8. Class X School Name *

9. Class X Passing Board Name *

10. Class X Board's

Roll Code *

Roll Number *

Marks Obtained *

% of Marks *

11. Passing Year *

12. Class XII School Name *

13. Class XII Passing Board Name *

14. Class XII Board's

Roll Code *

Roll Number *

Marks Obtained *

% of Marks *

15. Passing Year *

16. Gender *

Male
Female
Others

17. Caste Category *

18. Differentially abled *

No
Yes

Specify (if yes)

19. Nationality *

Indian

Others

(As per Rule)

20. Religion *

Others

21. Mobile no of Student (compulsary) *

22. E-mail Id *

23. Aadhar No

24. Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

25. Marital Status *

Married
Unmarried

26. Details of Subject Code 5-9 for Higher level of Primary (Class 6-9) Note: Tick any one option given below subject:- *

27. Medium *

Hindi
English

पंजीयत आवेदन में मेरे द्वारा भरा गया सभी विवरण सत्य तथा पूर्ण है |

28. Student's Signature in Hindi

Student's Signature in Hindi

29. Student's Signature in English

Student's Signature in English

प्रमाणित किया जा रहा है की ऊपर दिए गए सभी विवरण की जांच महविद्यालय में संधारित सभी अभिलेखों से पूर्णरूपेण कर लिया गया है , जो सही है | तदनुसार उक्त परीक्षार्थी का सूचीकरण आवेदन पत्र स्वीकार किया जाये |

30. Signature & Seal of Principal

Click or drag a file to this area to upload.

Signature & Seal of Principal