Name of the Student: Father's Name: Your email Contact Mobile Number1: Contact Mobile Number2: College Studying: Residential Address: Coaching Opted: NEETCETBoth Combination Opted: PCMBPCMPCB Hostel Facility Required? (If Outsiders of Chitradurga) YesNoMay be Bus Facility Required? (Conditions Apply) YesNoMay be Specially Abled? YesNo Any Additional Information wish to Provide (optional) Please prove you are human by selecting the Heart.