Application Form – MODERN MAHAVIDHYALA

RECOGNISED BY NCTE & AFFILIATED TO SCERT LUCKNOW

Modern Mahavidhyalaya

CODE – 390008

Student Name *

GenderMaleFemale

Date Of Birth

Religion

Category

Disability / Special ReservationYesNo

Aadhar Number *

Pan Card

Nationality

Phone *

Email *

Father's Name *

Father's Occupation

Father's Mobile No.

Mother's Name

Mother's Occupation

Mother's Mobile No.

Are you a Resident of U.P ? *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

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