Student Registration

University / Institution * (Office)

DBT PG Programme *

DBT PG Programme Coordinator *

Academic Year *

Academic Session *

Title*

Name in Full *

Gender *

Date of Birth (MM/DD/YYYY) *

Age * (age on deadline of submission of application)

Main Official Mobile Number 1 *

Additional Official Mobile Number 2

Additional Official Mobile Number 3

Main Official Email Address 1 *

Additional Official Email Address 2

Additional Official Email Address 3

Father’s Name

Mother’s Name

Spouse Name

Whether staying in University/Institution Hostel *

Year *

Reservation Category *

GAT-B Roll Number *