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