Online Classes Admission

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: / Batch

1. Student Name : *

2. Father / Mother Name : *

3. WhatsApp Number : *

4. Parent/Alternate Mobile Number : *

5. Name of the Village / Town & District : *

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Last

6. Qualification : *

7. Date of Birth ( DD/MM/YYYY ) : *

8. Gender : *

9. Community : *

10. Course Preferred : *

11. Batch Time Slot : *

12. Course Duration : *

13. Enrollment Status : *

14. Date of Joining ( DD/MM/YYYY ) : *

15. How did you know about us : *

16. Terms & Conditions : *

I hereby declare that all the information provided in this application is true and correct to the best of my knowledge. I agree to abide by the rules and regulations of VIJAYAM STUDY CIRCLE. Note : Fee once paid will not be refunded under any circumstances nor be adjusted in any way.

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