| 1. Name(Use CAPITAL Letters)*: | |
| 2. Date of Birth*: | | Gender*: | MaleFemale |
| 3. Medium in which you propose to take the classes: | |
| 4. Father's Name & Mob. No. *: | | |
| 5. Father's Profession: | |
Permanent Address*:
(in CAPITAL letters) | |
| PIN: | | Mobile: | |
Local Address*:
(in CAPITAL letters) | |
| PIN: | | Mobile*: | |
| 7. E-Mail Address*: | |
| 8. Mention the batch/session in which you propose to take classes: | Regular Classes | Weekend Classes |
| 9. Mention the course(s) you are enrolling for: | GS Integrated Course | Optional Subject |
| 10. Education Qualification: |
| Name of Exam | Year | Subjects | Board/University | % of Marks | Division/Rank | Medium |
| Class XII | | | | | | |
| Graduation | | | | | | |
| Post Graduation | | | | | | |
| Additional Qualification | | | | | | |
| 11. Mention the year in which you have completed your last examination: |
|
| 12. Optional subjects for the Main Exam: |
|
| 13. Have you appeared in the Civil Services/PCS Examination earlier ? If yes, give complete details: |
|
| 14. Family background in administration, if any: | |
| 15. Are you still a student? If yes, give details: | |
| 16. Are you employed? If yes, give details: | |
| 17. Mention the newspaper(s) you read: | |
| 18. Mention the magazine(s) you read: | |
| 19. Do you require hostel facility? | | No |
| 20. Has anybody recommended the Shiksha IAS Academy to you? If yes, tick appropraite box. |
| |
I hereby undertake to obey and comply with all the rules & regulations of Study Circle, which I have read and
understood, in force from time to time.
I further declare that the particulars/information given by me in this form are correct to the best of my knowledge. |
| Date: | | | Signature: | |
| Note- The decision taken by the Shiksha IAS Academy on your above application shall be final and binding, |
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