Mahamana Shikshan Sansthan Balika Prakalp

(Bhaorao Deoras Seva Nyas)

Application Form

[For IIT (JEE)/NEET(PMT) Preparation]

* Last date to submit Application form has been extended to 15-August-2021.

Important Instructions For filling Admission Form Click Here To Read

Only female students appeared in current year High School Examination need to apply

Select Target Course*

Registration Date*

1. Name*

2. Date of Birth*

3. Father's Name*

4. Mother's Name*

5. Gender*

6. Contact Number*

7. Email Address*

8. Select State*

9. Permanent Address*

10. Annual Family Income (From all sources)*

11. Number Of Sibling(s)*

12.(a) High School Subject & Marks*

Maths & Science % *

Marks Obtained*

Total Maximum Marks*

Total %

(b) Pre Board (Examination Marks )*

Maths & Science % *

Marks Obtained*

Total Maximum Marks*

Total %

(c) Half Yearly Class X(Examination Marks)*

Maths & Science % *

Marks Obtained*

Total Maximum Marks*

Total %

(d) Class IX (Examination Marks) *

Maths & Science %

Marks Obtained

Total Maximum Marks

Total %

13. Reference By Two Respected Persons Of The Society:

Name

Designation

Mobile

Upload Letter

Name

Designation

Mobile

Upload Letter

14. Student Photo *

Decleration by Parent

I do hereby declare that all the information furnished above is true and in case any information is found to be false at any stage, the candidature/admission may be cancelled.
I do hereby declare that I have read & understood the important instruction regarding filling the form & eligbility.

Place:*
Date:*

Upload Signature*

Helpline Number:- +91 - 9839412794 , 98214 83861