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RGCSM INVITING APPLICATION FOR STATE COORDINATORS, HARYANA, HIMACHAL PRADESH, JHARKHAND Vidhyarthi Prothsahan Yojna EXAMINATIONS DATE FOR ALL COURSES

Course Name

Course Code

Full Name of the Applicant
(as per certificate)

Father's Name
(as per certificate)

Mother's Name
(as per certificate)

Complete Address for Correspondence
(do not repeat name)

City

District

State

State Code

Pin Code

Telephone Number with STD Code

–

Mobile Number

Category

Date of Birth

Gender

Male Female

Medium

Detail of Qualifying Examination.

	Name of Board/University	College/School Name	Year of Passing	% Obtained
10th
12th
Degree
Others

Enter Characters Shown Above :

DECLARATION BY THE APPLICANT

I have read all the rules and regulation of the institute and admission to the course applied for. I declare that the above information is true and correct to my knowledge and belief and I fully understand that my admission will stan cancelled if any information by me is found to be false or twisted.