Aadhar No:
Course Applied For:
Medium of Study:
Class Applied For: Class Applied ForSecondarySenior Secondary

Name (In Capital Letters):
Father's Name (In Capital Letters):
Mother's Name (In Capital Letters):
Guardian’s / Institution Name (In Capital Letters):
Date of Birth:
Gender : GenderFemaleMaleTransgender
Mobile Number:
Telephone:
Social Category / Caste:
If Bc: YesNo
Types of Disability(if any):
Disadvantaged group(if applicable):
Your Previous Qualification:
Postal Address:

Choose Subjects ( Minimum 5 and Maximum7):
Are You Applying Under : Applying UnderPart AdmissionDual Enrollment
Details of 10th Board Examinations:

Orphan: NoYes
Mother Tongue:
Nationality:
Religion:
Employment:
Extra Curricular activities:
Father’s Educational qualification:
Mother’s Educational qualification:
Place of Residence:
Your Geographical Area:
Annual Income (in Rs.):
Economically Backward Class:
Ex- Serviceman :
Permanent Address:

Certificates Required: 9th Pass10th Marklist12th MarklistBirth CertificateAadhar CardCommunity CertificatePhotoSignatureTransfer/ Migration CertificateParent'sSignatureOBC Certificate (If BC)Declaration Scanned Documents: [multilinefile scancertireq limit:26214400 filetypes:jpg|jpeg|doc|docx|pdf "Upload Files"]Note: Upload Scanned Documents (Size: Below 25MB & Supported File:jpg, jpeg, doc, docx, pdf )

RULES & REGULATIONS

I understand and agree that the fees once paid is Non refundable

I Will give my 100 percent co-ordination to complete my 10th/12th Successfully by keeping in mind that the same will upgrade my career and academic Credential and If I Discontinue in between I understand that I will pay the relevant cancellation Charges

I wholeheartedly accepting all the specified rules and regulations of our Institution.

DECLARATION BY APPLICANT( TO BE FILLED BY ALL APPLICANTS )

I hereby declare that I have read and understood the conditions of eligibility and I fulfill the criteria for the courses for which I seek admission. I have furnished all the necessary documents and information correctly. I have filled this form in my own handwriting. I understand that my candidature is liable to be canceled by NIOS in the event any information or document is found misleading or incorrect at any stage. I accept the rules as laid down in the prospectus.

Date:

Bank Details for Dr. Ambedkar National Scholarship(applicable for SC and ST only) For details please see section 4.11

Academic Guide:

Academic Head:

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