Submitted by admin on Thu, 07/24/2014 - 19:36 Name of the Applicant * - Name of the Applicant (required) -Mr.MissMrs. Name of the applicant Name * Name Address * Address City * City State * - State (required) -Andaman and nicobar islandsAndhra pradeshArunachal pradeshAssamBiharChandigarhChhattisgarhDadra and nagar haveliDaman and diuDelhiGoaGujaratHaryanaHimachal pradeshJammu and KashmirJharkhandKarnatakaKeralaLakshadweepMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherryPunjabRajasthanSikkimTamil naduTelanganaTripuraUttarakhandUttar pradeshWest bengal State Pin Pin Phone Phone no. (max 10 digit) Mobile * Phone no. (max 10 digit) Email * Email Member name Parent/Guardian/Husband * - Parent/Guardian/Husband (required) -Mr.MissMrs. Member name Parent/Guardian/Husband2 * Relationship with Applicant * Relationship with applicant Occupation * Occupation Category * - Category (required) -Manual Scavenger/dependantSafai Karamchari/dependantWaste Picker/ dependant Category of Beneficiary Address * Address City * City State * - State (required) -Andaman and nicobar islandsAndhra pradeshArunachal pradeshAssamBiharChandigarhChhattisgarhDadra and nagar haveliDaman and diuDelhiGoaGujaratHaryanaHimachal pradeshJammu and KashmirJharkhandKarnatakaKeralaLakshadweepMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherryPunjabRajasthanSikkimTamil naduTelanganaTripuraUttarakhandUttar pradeshWest bengal State Pin * Pin Examination Passed Examination passed Name of the Institution Name of the institution Year of Passing Year of passing % of Marks Course Applied Duration Whether admission to College Secured? - Whether admission to College Secured? -YesNo Name of the Institution * - Name of the Institution (required) -Indian Institute of Management (IIM), AhmedabadIndian Institute of Management (IIM), BangaloreIndian Institute of Management (IIM), KolkataIndian Institute of Management (IIM), IndoreIndian Institute of Management (IIM), LucknowIIM Lucknow - Noida CampusIndian Institute of Management (IIM), KozikodeIndian Institute of Management (IIM), ShillongXavier Labour Relations Institute (XLRI), JamshedpurIndian School of Business (ISB), HyderabadISB - Mohali Campus Indian Institute of Management (IIM), RaipurIndian Institute of Management (IIM), RanchiIndian Institute of Management (IIM), RohtakIndian Institute of Management (IIM), TrichyIndian Institute of Management (IIM), UdaipurIndian Institute of Management (IIM), KashipurIndian Institute of Technology (IIT), MumbaiIndian Institute of Technology (IIT), KanpurIndian Institute of Technology (IIT), ChennaiIndian Institute of Technology (IIT), KharagpurIndian Institute of Technology (IIT), GuwahatiIndian Institute of Technology (IIT), DelhiIndian Institute of Technology (IIT), RoorkeeIndian Institute of Technology (IIT), GandhinagarIndian Institute of Technology (IIT), RoopnagarIndian Institute of Technology (IIT), JodhpurIndian Institute of Technology (IIT), HyderabadIndian Institute of Technology (IIT), PatnaIndian Institute of Technology (IIT), BhubaneswarIndian Institute of Technology (IIT), MandiIndian Institute of Technology (IIT), IndoreIT BHU, Banaras (converted into IIT Varanasi)Faculty of Management Studies (FMS), DelhiIIT-SJSOM, MumbaiIndian Institute of Foreign Trade (IIFT), DelhiIndian Institute of Foreign Trade (IIFT), Kolkata CampusInstitute of Management Technology (IMT), GhaziabadDept of Management Studies, IIT, DelhiNarsee Monjee Institute of Management andHigher Studies (NMIMS), MumbaiJamnalal Bajaj Institute of Management Studies (JBIMS), MumbaiNirma Institute of Management, AhmedabadS P Jain Institute of Management and Research (SPJIMR), MumbaiXavier Institute of Management (XIM), BhubaneswarSymbiosis Institute of Business Management (SIBM), PuneManagement Development Institute (MDI), GurgaonNational Institute of Industrial training (NITIE), MumbaiDept of Industrial and Management Engineering, IIT, KanpurMarine Engineering College, KolkataDelhi College of Engineering (DCE), DelhiBirla Institute of Technology and Science (BITS), PilaniCollege of Engineering, Guindy (Anna University)Madras Institute of Technology (Anna University)Alagappa Chettiar College of Technology (Anna University)College of Structural and Architectural Planning (Anna University)National Institute of Design (NID), AhmedabadChristian Medical College (CMC), VelloreBangalore Medical College (BMC), BangaloreJawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), PondicherryMadras Medical College (MMC), ChennaiGrant Medical College (GMC), MumbaiArmed Forces Medical College (AFMC), PuneKing Edward Medical College (KEMC), MumbaiMaulana Azad Medical College (MAMC), DelhiAll India Institute of Medical Sciences (AIIMS), DelhiLady Hardinge Medical College (LHMC), DelhiKasturba Medical College (KMC), ManipalPost Graduate Institute of Medical education and Research (PGIMER), ChandigarhIndian Institute of Forest Management (IIFM), BhopalMudra Institute of Communication (MICA), AhmedabadIndian Institute of Science (IISC), BangaloreInstitute of Rural Management, Anand (IRMA)Tata Institute of Social Sciences (TISS), MumbaiIndian School of Mines (ISM), DhanbadNational Institute of Technology (NIT), WarangalNational Institute of Technology (NIT), TiruchirapalliNational Institute of Technology (NIT), SurathkalNational Institute of Technology (NIT), RaipurNational Institute of Technology (NIT), RourkelaNational Institute of Technology (NIT), KurukshetraNational Institute of Technology (NIT), CalicutNational Institute of Technology (NIT), DurgapurNational Institute of Technology (NIT), JamshedpurNational Institute of Technology (NIT), PatnaNational Institute of Technology (NIT), SilcharNational Institute of Technology (NIT), AgartalaNational Institute of Technology (NIT), HamirpurNational Institute of Technology (NIT), SrinagarMalaviya National Institute of Technology (NIT), JaipurMaulana Azad National Institute of Technology (NIT), BhopalSardar Vallabh Bhai National Institute of Technology (NIT), SuratMotilal Nehru National Institute of Technology (NIT), AllahabadDr. B R Ambedkar National Institute of Technology (NIT), JalandharVisvesvaraya National Institute of Technology (NIT), NagpurBirla Institute of Technology and Science (BITS), Hyderabad CampusBirla Institute of Technology and Science (BITS), Goa CampusBirla Institute of Technology (Mesra), RanchiSt. Johns Medical College, BangaloreChristian Medical College (CMC), LudhianaDayanand Medical College (DMC), LudhianaAmrita School of Medicine (ASM), KeralaNetaji Subash Institute Of Technology (NSIT), DelhiDhirubhai Ambani Institute of Information and Communication Technology (DAIICT), GandhinagarUniversity College of Engineering (UCE), BurlaLN Mittal Institute of Technology (LNMIT), JaipurFaculty of Engineering and Technology, Jadavpur University, KolkataVeermata Jeejabai Technical Institute (VJTI), MumbaiCollege of Engineering , PuneUniversity Institute of Chemical Technology (UICT), MumbaiCentre for Environmental Planning and Technology (CEPT), AhmedabadSchool of Planning and Architecture, New DelhiNational Law School of India University (NLSIU), BangaloreNational University of Juridical Sciences (NUJS), KolkataLoyola Institute of Business Administration (LIBA), ChennaiSymbiosis Centre For Management And HRD (SCMHRD), PuneOthers Others Address City State * - State (required) -Andaman and nicobar islandsAndhra pradeshArunachal pradeshAssamBiharChandigarhChhattisgarhDadra and nagar haveliDaman and diuDelhiGoaGujaratHaryanaHimachal pradeshJammu and KashmirJharkhandKarnatakaKeralaLakshadweepMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherryPunjabRajasthanSikkimTamil naduTelanganaTripuraUttarakhandUttar pradeshWest bengal Pin Own Contribution (Margin) Rs. Total Course Expenses (Fee + Hostel Expenses, etc.) Rs. Loan Amount Required Rs. Any Other Information