Online Registration For Felicitation Program | State Toppers' Felicitation Program

Student name *

Father's name *

Mother's name *

Father's occupation *

Mother's occupation *

Date of Birth *

Gender *

Boy

Girl

Caste *

Contact Number (Mobile) *

Email ID *

District where student resides *

School Name *

District where school is located *

Examination Passed *

Rank Secured (state level) *

Total marks Obtained *

% of Marks Obtained *

Hobby (Within 20 words) *

Hours of effort for success *

Your Model/Hero(within 100 characters) *

To whom do you want to dedicate your success(within 100 characters) *

Aim/Dream of life (Within 20 words) *

Your Success Mantra (Within 50 words) *

Bank Account Details of Candidate (optional). Required for disbursement of scholarship etc.

Bank Name:

Branch

Name of the account holder

Account No.

IFS Code

Upload Student photograph [Image should be in .jpg,.jpeg,.png format only and image size must be within 200 KB]

Upload Student Signature [Image should be in .jpg,.jpeg,.png format only and image size must be within 200 KB]