Eshiksa

Shri Venkateshwar Balaji Education

INDIA NEPAL BHUTAN SRILANKA SINGAPORE MALYASIA

Admission Cum Registration Form

Applicant fill Information :

Blood Group:

Registration Number:

Session:

Counselor Name:

Counselor Code:

Student Name:*

Father Name:*

Mother Name:*

Date of Birth:*

Medium:*

Caste:*

Applicant select University Country and Course :

University Country:*

Indian University:*

Indian University Course:*

Medical Course:*

Dental Course:*

Dental MDS Course:*

Homeopathy Course:*

Homeopathy MD Course:*

Ayurved Course:*

Ayurved MD Course:*

Nursing Course:*

Nursing MSc. Course:*

Engineer Course:*

Diploma of Engineer Course:*

Diploma courses 3 Year 10th Any with 45% General, St/Sc 40% .

Bachelor of Engineer Course:*

Bachelor Engineering 4 year, Eligibility 12th with PCM 45% General, St/Sc 40%
If Diploma Engineering then Lateral Entry 3 year (1 year Relaxation)

Master of Engineer Course:*

Master In Engineering Duration 2 year Eligibility BE/B.tech Relevant Course 50% Gen, ST/SC 45%.

Vocational Course:*

Pharmacy Course:*

Management Course:*

MBA Course:*

Computer Science Course:*

Law Course:*

Library Science Course:*

Education Course:*

Physical Education Course:*

Agriculture Course:*

Arts Course:*

Commerce Course:*

Science Course:*

Journalism & Mass Communication Course:*

Yoga Course:*

Fire Safety Course:*

Fashion Designing Course:*

Animation & Multimedia Course:*

Peramedical Science Course:*

Duration Certificate Courses 1 year, Diploma Courses 2 year, BMLT 3 year, BPT 4.5 Year
Eligibility : Higher Secondary School Certificate Examination 10+2 Science with Physics, Chemistry & Biology Conducted By M.P Board & Other Secondary Board Equivalent or Eligibility Criteria Prescribe by paramedical council of M.P

Abroad University:*

Abroad Medical University:*

Abroad Medical Course:*

Italy University:*

Italy Course:*

Italy Mechanical & Automobile Engineering Course:*

Italy Civil Engineering & Architecture Course:*

Italy Pharmaceutical Course:*

Italy Commerce Course:*

Italy Hotel Management Course:*

Italy Agricultural Course:*

Italy Medicine Course:*

Italy Management Course:*

Italy Science Course:*

Italy Arts Course:*

USA University:*

USA Course:*

USA Under Graduate Course:*

USA BFA Course:*

USA Master Computer Course:*

USA MBA Course:*

Occupationt:

Father's/Husband's occupation:*

Mother occupation:*

Yearly Income:

Father income:*

Mother income:

Mobile No:

Father mobile no:*

Mother mobile no:

Guardian mobile no:

Address:

Permanent Address:*

District:*

State:*

Pin Code:*

Phone number (with STD code):

Student Mobile Number:*

E-mail Address:*

Detail of Entrance Exam conducted by the Govt./University:

Name of Exam:	Roll No:	Max Marks:	Marks Obtained:	Percentage:	Merit Rank:

Detail of the educational Progress of the applicant:

Exam:	Year:	Educational Institute:	Name f Board/University:	Marks Obtained:	Max Marks:	%:	Division:	Subject/Group:
1	2	3	4	5	6	7	8	9
10th:*
12th:*
Graduation:
Post Graduation:
B.ed (For M.ed):
M.Phil:

Optional Subjects for Applied Course (If applicable):

Optional Subject 1:

Optional Subject 2:

Optional Subject 3:

Optional Subject 4:

Optional Subject 5:

Optional Subject 6:

Registartion Amount:

Payment Mode: