GUSHKARA MAHAVIDYALAYA (DAY SECTION)
GUSKARA, AUSGRAM
,
PURBA BARDHAMAN, PIN 713128, W.B.
Phone No. :
03452-255105
8170883833
Application Form - Certificate Course in Yoga
Maximum Photo Size 30KB
Maximum Signature Size 20KB
Applicant Name(Block Letter) :
* Name is Required!
Gender :
Male
Female
* Gender id Required
Blood group :
Mother's Name :
* Mother name is Required
Father's Name :
* Father name is Required
Category :
UR
SC
ST
OBC A
OBC B
* Category is Required
Do you belong to Physically Challenged category? :
Yes
No
* Required
Nationality :
Indian
Other
* Nationality is Required
Date of Birth :
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
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24
25
26
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30
31
* Day Not Selected!
Month
01(Jan)
02(Feb)
03(Mar)
04(Apr)
05(May)
06(Jun)
07(Jul)
08(Aug)
09(Sep)
10(Oct)
11(Nov)
12(Dec)
* Month Not Selected!
Year
1936
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2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
* Year Not Selected!
Are you a student of GUSHKARA MAHAVIDYALAYA (DAY SECTION) at present?
Are you a student of GUSHKARA MAHAVIDYALAYA (DAY SECTION) at present?
Yes
No
* Required
If yes then Section :
Day
Morning
Department :
Semester :
Class Rollno :
Contact Details
Whatsapp No. :
* Mobile No is Required!
Contact No. :
* Mobile No is Required!
Email Id :
Permanent Address Details
House No.& Street:
* Required!
Village/Town/Society:
* Required!
Post Office/City:
* Required!
District:
* Required!
State:
* Required!
Pincode:
* Required!
Previous Examination Details(12th/+2 & Others)
Examination
Passed
Board/Council
University
Registration No.
with Year
Year of
Passing
Marks
Obtained
Total
Maximum Marks
Percentage
Division/
Class
* Required!
* Required!
* Required!
* Required!
* Required!
* Required!
* Required!
Last Institution attended with address :
Institution:
* Required
Address:
* Required
Why you are interested in this course?
* Required
I agree to pay the course fee(Rs. 2000.00)in full at the time of admission. I know that the admission fee is non-refundable. I also hereby declare that the information given here are true and if found false my candidature may be cancelled.
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