Welcome Student

Application Form

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Please fill & select carefully
 
Name of Student*   Father/Husband Name*
Mother Name  
Gender*
  Date Of Birth  
Age*   Adhar Number
Interested to Work out of Rajasthan
 
Religion*
 
Caste*
   
Physically disabled*
  EPIC Number
Educational Qualification*
 
PIP of SHG*
Gramsabha Selection*
Name of the Course*




Whether Family is Income Tax Payee
Family Income(Annual)
   
Family Occupation
   
Have you done RMOL/RSLDC courses ?*
Economy Status*
BOCW Worker*
MGNREGA Worker*
Proposed By*
Area*
Address Details:-
House Number*   Street/Colony Name*
Ward Number   Village/Town/City Name*
Panchayat Samithi/Block Name   Rural/Urban*
District Name*
  Tehsil Name*
Municipality/Panchayat Samiti*
  Pincode*  Ex: 500364 or must 6 digits
Contact Details:-
Mobile Number*  Ex:9934599993 or 10digits only   Landline Number
Alternate Mobile Number*  Ex:9934599993 or 10digits only   e-Mail(if any)
Upload Candidate Photograph
Supported Format: .jpg, .jpeg, .png
All fields marked * are mandatory.