Student Application Form

B.G.S. @ Bahumuki Gramunnayan Samity

Student's Enrollment Form | Registration Fee: ₹ 700/-

Administrative / Enrollment Details

Center Code

Date of Enrolment

Registration No.

Module (if applicable)

Course *

Project

Founder / Donor

Personal Identity

Communication Details

Contact No. *

Alternative No.

Landline No.

Email ID

Pin Code

Police Station

Demographic Type

Urban Semi-urban Rural Tribal

Current Address

Permanent Address

Education & Occupation

Language Skills

Language	Read	Write	Speak
English
Hindi
Local

Livelihood Preferences

Any Computer Knowledge?

Currently Employed?

Yes No

Willing to Relocate for Job?

Yes No

Highest Educational Qualification

Roll No.

Year of Passing

Board / University Name

Marks %

Family Details

Father's Name

Father's Occupation

Mother's Name

Mother's Occupation

Husband's Name

Husband's Occupation

No. of Family Members

Earning Members

Monthly Family Income

< ₹2,000 ₹2,000–4,000 ₹4,000–8,000 > ₹8,000

BPL Card Holder?

Yes No

Other Details

How did you know about BGS?

Mandatory Documents Checklist

Payment Reference

Pay ₹700 to: Axis Bank | A/C: 920020065999414 | IFSC: UTIB0004441 | Name: DAKSHINNAGARTALA BAHUMUKHI GRAUNNAYAN SAMITY
After payment, enter the UTR / transaction reference number below.

UTR / Transaction Reference No.

Or email your application to: [email protected]

+91 98312 90080

[email protected]

Survey Park, Kolkata-700075

B.G.S. @ Bahumuki Gramunnayan Samity

Administrative / Enrollment Details

Personal Identity

Communication Details

Education & Occupation

Family Details

Other Details

Mandatory Documents Checklist

Payment Reference