Candidate Photo Scan
(240px X 320px)
1
Name of the Candidate
2
Name of the Father / Guardian
3
Address
4
Address for Communication
5
Occupation of Father
6
Annual Income
7
Name of the Mother
8
Date of Birth
9
Mobile No.
10
STD Code
11
Phone No.
12
E-mail
13
Religion
14
Nationality
15
Caste
(Enclose attested copy of Certificate, if you belong to SC / ST or O.B.C.)
16
Sex
Male Female
17
Height
18
Weight
19
Native State
20
District
21
State of Domicile
22
Blood Group
23
Passport No.
24
Extra Curricular Activities
(Attach a separate sheet if required)
25
How did you come to know about Career Potter ?
Newspaper
Reference
TV
Radio
Website
Others
26
Course & Colleges Preference
Course 1
Course 2
Course 3
College 1
College 2
College 3
27
Details of Qualifying Examination
Name of Examination
Register No.
Name of School / College / Uni. & Board, State & Country
No. of Attempts
Medium of Instruction
Year of passing
28
Details of Marks Obtained in the Qualifying Examination
29
Enclosed following documents:
30
Other Exams Appeared