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Dr. Rizvi Learners' Academy
Education for Equality Elegance & Excellance
Online Registration Form (
2023 - 24
)
REGISTRATION NO :
7
Applied Class For * :
Play Group
Prep
Nersury
LKG
UKG
I
II
III
IV
V
VI
VII
VIII
IX
X
XI Comm
XI Arts
XI Sc
XII Comm
XII Arts
XII Sc
Upload Photo (Photo Size Max 100KB) * :
Personal Detail
Applicant Name * :
*
Date Of Birth * :
*
Nationality * :
*
Religion * :
Hindu
Muslim
christian
Sikh
Other
*
Category * :
General
OBC
SC
ST
*
Gender * :
Male
Female
*
Address * :
*
City * :
*
State * :
*
Pin * :
*
Mobile No. * :
*
Email :
Parent Details
Father Details
Father Name * :
*
Mobile No. * :
*
Email :
Occupation * :
*
Organization :
Office address :
Landline Number (Office) :
Mother Details
Mother Name * :
*
Mobile No. * :
*
Email :
Occupation * :
*
Organization :
Office address:
Landline Number (Office) :
Local Guardian Details (if any)
Name :
Mobile No. :
address:
Landline Number (Home) :
Qualification Details
Last Attended Class :
Year :
School Name :
School Board Name :
Address of School:
Result Of Last Exam (%) :
I certify / agree that I filled up all the entries are correct. If the statement is inaccurate and untrue my application automatically be canceled and legal proceedings should be against me.