DMA, Rampur

Dayawati Modi Academy Rampur (U.P.)

Registration Form

Fields marked with (*) are mandatory.

CANDIDATE'S PERSONAL DETAILS

First Name*

Middle Name

Surname

Date Of Birth*

Religion*

Category*

Nationality*

Gender*

MaleFemale

ACADEMIC DETAILS

Class in which admission sought*

PARENT'S DETAILS

Single Parent ?

FATHER'S / GUARDIAN'S DETAILS

First Name*

Middle Name

Surname

Mobile No

Qualification*

Degree*

Occupation*

Annual Income*

School Alumni

If Yes

Ever Awarded

If Yes

Click on plus sign () to add more award's details or () to remove
(1) Award Type*			Award Name*			Description*
(2) Award Type*			Award Name*			Description*
(3) Award Type*			Award Name*			Description*

MOTHER'S DETAILS

First Name*

Middle Name

Surname

Mobile No

Qualification*

Degree*

Occupation*

Annual Income*

Ever Awarded

If Yes

Click on plus sign () to add more award's details or () to remove
(1) Award Type*			Award Name*			Description*
(2) Award Type*			Award Name*			Description*
(3) Award Type*			(3) Award Name*			Description*

CONTACT DETAILS

Permanent Address*

State*

City*

Area*

Landline No

Parent Email

Distance from residence to this school*

SIBLING DETAILS (Only Real Brothers)

Real Brothers Studying In This School

Click on plus sign () to add more brother's details or () to remove
(1) Name*		SR NO.*		Date Of Birth*		Class*
(2) Name*		SR NO.*		Date Of Birth*		Class*
(3) Name*		SR NO.*		Date Of Birth*		Class*

UPLOAD PHOTOS

Student's Photo*

Father/Guardian's Photo*

Mother's Photo*

Student Photo File Size Limit 60 Kb

Father/Guardian's Photo File Size Limit 60 Kb

Mother's Photo File Size Limit 60 Kb

Father/Guardian's Signature*

Father/Guardian's Signature File Size Limit 40 Kb

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