ADMISSION Form / Examination Form
1. Registration Details*(Mandatory fields)
Courses*	--Select-- Silai - Kadai Management Beauty Parlour Management Painting Management Mahandi Management Dholak Management Other Management Training Certificate Mobile Repairing. Training Certificate in AC Repairing. Training Certificate in Invertor & Stabilizer Repairing Certificate in Computer Typing ( Hindi & English) Certificate of Rural Development. Training Certificate in NGO Management. Training Certificate in Auto Mobile Engg. Training Certificate in Hair Style Certificate in Spoken English & Personality Development. Training Certificate in Computer Operation. Self Employed Tailor. Construction Digital Electronic Certificate Course Electronic & Hardware Food Processing Furniture & Fitting Handicraft & carpets Health Care Management Entrepreneurship & Professional Retails Plumbing Textiles & Handlooms Tourism & Hospitality Certificate of Naturopathy & Yogic Science Certificate in Electrical Gramin Jagrukta Abhiyan Nishulk Bhojan Vitran Abhiyan Nishulk Mohlla Coaching Center Nishulk Tulsi Vitran Abhiyan Gau Seva Abhiyan Swasth Jagrukta Abhiyan Pariyavarn Kalyan Abhiyan Youa Vikas Kalyan Abhiyan Shahree Jagrukta Abhiyan Viklang Jagrukta Abhiyan COVID -19 Jagrukta Abhiyan Pariwar Kalyan Vikas Abhiyan Nishulk Pustak Vitran Abhiyan Kanya Daan Seva Abhiyan Krishi Jagrukta Abhiyan Digital Seva Abhiyan Member Ship Active Member Training Certificate in Computer Operation ADCA.BCC.DCA
Student full name *	--Select-- Mr. Ms. Km. (Full name as per the highest / latest qualification certificate or legal certificate)
Father's Name*	Mr. (Full Name As Per Educational/Legal Certificate)
Mother's Name*	Mrs. (Full Name As Per Educational/Legal Certificate)
Date of Birth*(dd-Mon-yyyy)	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month 1 2 3 4 5 6 7 8 9 10 11 12 Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 (As per high school certificate in 'dd-Mon-yyyy' format. i.e. '01-Jan-1990')
Category*	General OBC SC/ST
Gender*	Male Female
Address*
Pin Code
State*
Email Address	(e.g.abc@yahoo.com)
Mobile Number*
Academic Qualification*
Center Code*	Center Status
Voter ID#/Adhaar ID#/PAN #
Exam Mode*	Offline Online Semester Mode Yearly Mode On Demand
Examination Center *
Study Mode *	Regular Distance
Upload Photo*	(JPG,JPEG,GIF,PNG image with size upto 50 KB)
Upload Student Signature *	(JPG,JPEG,GIF,PNG image with size upto 50 KB)
Declaration *	I, hereby declare that the particulars submitted by me in the online application form of Dana Pani Seva Sansthan are true to the best of my knowledge and belief. I agree to abide by the rules and regulations of Dana Pani Seva Sansthan and also to the decision of Dana Pani Seva Sansthan regarding any action. I will not held Dana Pani Seva Sansthan responsible for any damages. I hereby accept that, if the number of Candidates is less than minimum required, Dana Pani Seva Sansthan can move my registration to the Second Preference City even after I submit the consent to First Preference City.