Full Name As Per 10+2 Mark Sheet : *

Date of Birth : *

Mobile No  : *

Parent's/Guardian Mobile No :*

Student's Email ID : *

Aadhar Card No.: *

Full Name As Per Aadhar Card: *

Year of Enrollmnet : * Select year of enrollment 2023 2022 2021 2020 2019 2018 2017 2016

PRN No. : *

Name of College : * Select Name of College D. Y. Patil Medical College D. Y. Patil College of Nursing Center For Interdisciplinary D. Y. Patil College of Physiotherapy D. Y. Patil School of Hospitality D. Y. Patil College of Pharmacy D. Y. Patil School of Allied Heath Science D. Y. Patil School of Engineering & Management

Program Name : * Select Name of Program

Studing Year : * Select Year

Religion:* Select Religion Hindu Christianity Sikhism Muslim Buddh Jain Parsis Judaism Atheism Other

Category:* Select Category General OBC ST SC

Caste:*

Economical Weaker Section (EWS):* Select EWS No Yes

Physical Weaker Section (PWS):* Select PWS No Yes

Minority:(if applicable)

Title of Thesis:

Name of Guide :

IEC Approved Status: Select IEC Approved Status No Yes