ACADEMIC SESSION
APPLICATION FOR
SPECIALIZATION
COUNSELLOR
PERSONAL INFORMATION
STUDENTS NAME
FATHER’S NAME
DATE OF BIRTH
NATIONALITY
GENDER
MARITAL STATUS
CONTACT INFORMATION
CORRESPONDENCE ADDRESS
PERMANENT ADDRESS
EMAIL ID
OFFICE NO.
PERSONAL NO.
RESIDENTIAL NO.
ACADEMIC QUALIFICATION INFORMATION
WORK EXPERIENCE INFORMATION
APPLICATION’S PROFESSION (Please Select)
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I declare that above information furnished by me is correct to the best of my knowledge. I also understand that if any of my
above statement are found to be untrue. I may be disqualified from the course. I undertake that I shall abide by the rules and regulations
of the institution.
Confirm the Declaration :