Registration Form

Preferred College Name(Required)

Student Image(Required)

Max. file size: 1 MB.

Abailable course in KRISHNA INSTITUTE OF HIGHER EDUCATION-Patna(Required)

Available course in Krishna Institute of Paramedical Sciences, Purnea(Required)

Available Course in VIHE, Samastipur(Required)

Available Course in KINPS, Samastipur(Required)

Available Course in KIHE, Madhepura(Required)

Full Name of the Applicant(Required)

Father’s Name(Required)

Mother’s Name(Required)

Nationality

Date of Birth(Required)

Sex

Category

Aadhar No.

Migration No.

Migration Issue Date

Complete Correspondence Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile No-1(Required)

Mobile No-2

Email ID(Required)

Complete Permanent Address :

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Matric Board Name

Intermediate Board Name

Intermediate Appearing Board Name

Other Board Name

Matric Passing Year

Intermediate Passing Year

Intermediate Appearing Passing Year

Other Passing Year

Subject in Matric

Subject in Inter

Subject in Intermediate Appearing

Subject in Other

Marks % in Matric

Marks % in Inter

Marks % in Intermediate Appearing

Marks % in Other

Division in Matric

Division in Inter

Division in Other

Enclosed xerox copy of 10th and 12th(Required)

Marksheet

Certificate

S.L.C./ C.L.C

Provisional Certificate

Aadhar

Migration certificate must be attached Original.

Source of Information for this Entrance Examination(Required)

Place

Date

Candidate Signature in Hindi

Max. file size: 1 MB.

Candidate Signature in English

Max. file size: 1 MB.

Parent’s/ Guardian’s Signature

Max. file size: 1 MB.