Student App ID No. for Registration
Have you passed in Paramedical Course?	Yes, I am passedNo, I am not passed यदि छात्र की अंकसूची का अवलोकन करने पर छात्र उसमें अनुत्तीर्ण शो होता है तो उसका फार्म निरस्त कर दिया जावेगा।
Admission Session *	--- Select Session --- 1981-82 1982-83 1983-84 1984-85 1985-86 1986-87 1987-88 1988-89 1989-90 1990-91 1991-92 1992-93 1993-94 1994-95 1995-96 1996-97 1997-98 1998-99 1999-2000 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 2021-22 2022-23	District *	--- Select District --- Agar Malwa Alirajpur Anuppur Ashoknagar Badwani Balaghat Betul Bhind Bhopal Burhanpur Chhatarpur Chindwara Damoh Datia Dewas Dhar Dindori Guna Gwalior Harda Hoshangabad Indore Jabalpur Jhabua Katni Khandwa Khargone (Mandleshwar) Mandla Mandsour Morena Narsinghpur Neemuch Panna Raisen Rajgarh Ratlam Rewa Sagar Satna Sehore Seoni Shahdol Shajapur Sheopur Shivpuri Sidhi Singroli Tikamgarh Ujjain Umaria Vidisha
College Name*
Course Type *		Course *
Date of Admission		Paramedical's Course Passing Date(dd/mm/yyyy)
Is Center Closed *	Yes     No	Total Duration of Course	(yy/mm/dd)

Personal Details
Name *
Father/Husband Name *
Gender *	FemaleMale	Category *	URSCSTOBC
Religion *	HinduMuslimSikhChristianOther
Marital Status *	MarriedUnmarried
Date Of Birth *
Age *	// (yy/mm/dd)
Mobile Number *		E-Mail *
Domicile *	MPOTHERS	Nationality *	INDIANOTHERS

Address
Current Address *		Current Pin No. *
Permanent Address(Same as Current Address)
Permanent Address *		Permanent Pin No. *

Qualification details
Exam Name*	Board Name*	Pass Year*	Roll Number*	Subject*	Total Marks*	Obtain Marks*	Percentage*
SELECT 8th 10th
SELECT 11th 12th				-SELECT-
Paramedical

Upload Your Photo only in jpg and jpeg format (With signature and Thumb impression) *
Upload Image

Enclosures (Upload Documents should be 200 kb to 250 kb)
1.	10th Marksheet *
2.	12th Marksheet *
3.	Domicile Certificate *
4.	Caste Certificate
5.	Transfer Certificate / Migration/College Authentication Letter *
6.	Affidavit (If Center Closed, upload Affidavit)
7.	Paramedical Marksheet *

Important Note*
छात्र के द्वारा Student App ID No. for Registration केवल पंजीयन करवाये जाने हेतु प्राप्त कर रहा है अन्य किसी दावा, आपत्ति जैसे छात्रवृत्ति आदि के लिये इसका किसी प्रकार से उपयोग नही करेगा।
Declaration
*मैं प्रमाणित करता हूं कि आवेदन पत्र में मेरे द्वारा दी गई उपरोक्त जानकारी सही है। यदि कोई भी सूचना असत्य पाई जाती है तो मेरा आवेदन निरस्त कर दिया जाये तथा किसी भी प्रकार की हानि की समस्त जिम्मेदारी मेरी होगी।
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