Atal Bihari Vajpayee Hindi Vishwavidyalay – Student Information Form (Guidance Only)

1. Course Details

Select Course *
Select CourseDiploma in First Aid Treatment (प्राथमिक चिकित्सा उपचार)Diploma in Basic Health Care (आधारभूत स्वास्थ्य संरक्षण)Diploma in Hospital Management (हॉस्पिटल मैनेजमेंट)Diploma in Electro Homeopathy (इलेक्ट्रो होम्योपैथी)PG Diploma in Basic Health Care (PG डिप्लोमा)प्राकृतिक चिकित्सा एवं योग डिप्लोमाप्राकृतिक फार्मा डिप्लोमाप्राकृतिक फार्मा — Diploma in Natural Pharmaखेल में चोट का निदान एवं प्रबंधन — Diploma in Sports Injury Diagnosis and Managementफायर सेफ्टी एवं हजार्ड मैनेजमेंट — Diploma in Fire Safety and Hazard Managementइंडस्ट्रियल सेफ्टी — Diploma in Industrial Safetyआहारिकी एवं जन स्वास्थ्य पोषण — Diploma in Dietetics and Public Health Nutritionडिजास्टर मैनेजमेंट — Diploma in Disaster Management

2. Student Personal Details

Applicant Name *

Blood Group
Select Blood GroupA+A-B+B-AB+AB-O+O-

Gender *
Select GenderMaleFemaleOther

Date of Birth *

Father / Husband Name (English) *

Mother Name (English) *

Father / Husband Name (Hindi)

Mother Name (Hindi)

Family Annual Income (INR) *

Category *
Select CategoryGeneralOBCSCSTEWSOther

Nationality *

Identification Proof Type *
Select ID ProofPAN CardAadhaar CardVoter IDPassportDriving LicenceOther

Identification Number *

Are you a domicile of Madhya Pradesh? *
YesNo

3. Current Address

Current Address Line *

Current City *

Current State *

Current Pin Code *

4. Permanent Address

Permanent Address Line *

Permanent City *

Permanent State *

Permanent Pin Code *

5. Contact Details

Mobile Number *

Email Address *

6. Educational Qualification - High School / 10th

10th Board / University Name *

10th Other Board / University Name

10th Year of Passing *

10th Total Marks *

10th Marks Obtained *

10th Roll Number / Enrollment Number *

10th Percentage *

7. Educational Qualification - Higher Secondary / 12th

12th Board / University Name *

12th Other Board / University Name

12th Year of Passing *

12th Total Marks *

12th Marks Obtained *

12th Roll Number / Enrollment Number *

12th Percentage *

8. Educational Qualification - Graduation

Graduation Board / University Name *

Graduation Other Board / University Name

Graduation Year of Passing *

Graduation Total Marks *

Graduation Marks Obtained *

Graduation Roll Number / Enrollment Number *

Graduation Percentage *

9. Additional Information

Have you ever faced disciplinary action from any institution? *
NoYes

If yes, provide details

Are you currently pursuing any other degree / diploma? *
NoYes

If yes, provide details

10. Declaration

Place *

Date *

Applicant Full Name as Signature *

Disclaimer:This form is for collecting student information for guidance purposes only. Filling this form does not guarantee admission or represent official enrollment at Atal Bihari Vajpayee Hindi Vishwavidyalay. Your details will be used solely to provide course guidance and support.