Place Of Registration : _________________________________________________________________________________

Name : _____________________________________________________________________________________________

Address : ___________________________________________________________________________________________

___________________________________________________________________________________________________

Telephone : __________________________________________________________________________________________

E-mail : _____________________________________________________________________________________________

Qualification : ________________________________________________________________________________________

Language Of Instruction in School : ________________________________________________________________________

Payment Mode :     Rs. 250/-     Thru   Cash     DD  

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                                                                                                                                                                             Signature

____________________________________________________________________________________________________

For Official use only

The applicant is admitted / not admitted to the course

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Place : _________________                                                                                                                                 Signature

Date : _________________                                                                                                                            Director / Principal

                                                                                                                                                                              of the Centre