Geetha Jeevan Arts & Science College

Name of the student * :

Date of Birth * :

Age * :

Gender:*

Religion:*

Caste * :

Community:*

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Place * :

District * :

Name of the Father * :

Father's Occupation * :

Father's Monthly Income (For statistical purpose only) * :

Name of the Mother * :

Mother's Occupation * :

Mother's Monthly Income (For statistical purpose only) :

Name of Brother/Sister if any studying in this college :

Permanent Address:*

Temporary Address :

Mobile No. * :

Alternative Mobile No. *:

E-mail * :

Admission