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Student Details

Student's Name*

Course*

Date of Birth*

Nationality*

Mobile No.*

Campus*

Place of Birth*

Religion *

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Category *

General

Backword

Gender *

Male

Female

Address for Communication*

Pincode*

City*

State*

Country*

Permanent Residential Address

Same as above

Address*

Student Contact Details:

Mobile No.*

Alternative Mobile No.

Aadhar No*

Guardian Personal Details – Guardian 1

Name of Father*

Father’s Occupation

Monthly Income

Father/Guardian Contact No.

Name of Mother*

Mother’s Occupation

Monthly Income

Mother’s Contact No.

Local Guardian Details – Guardian 2

Guardian’s Name

Guardian’s Mobile No.

Guardian’s Alternative Mobile No.

Other Information

Whether already enrolled in Lucknow University/ Dr. RML Awadh University. *

Yes

Marital status *

Married

Unmarried

Period of the Residence of Uttar Pradesh

Whether in Service?

Last College from Where XII or equivalent Exam Passed

Qualification Details

Name of Examination	Board/University	Year	Subjects	Marks Obtained	Total Marks
High School
Intermediate
B.A., B.Sc., B.Com. & Others
D.El.Ed., B.Ed., B.El.Ed
M.A., M.Sc., M.Com. & Others
Any Other Course

Subject Selected

General Subject Offered

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Verified that the contents of this self declaration are true to the best of my knowledge and no part of the self declaration is false and nothing has been concealed or misstated therein.