Pankh:Student Registration Form

Personal Details

Full Name (as per Aadhar Card):*

Date of Birth:*

Gender:*

Male

Female

Third Gender

Type of Disability:*

Mobile Number:*

Email Address:*

Level of Disability (in percentage):*

Aadhar Number:*

Marital Status:*

Residence Details

Address:*

State:*

City:*

Pincode:*

Education details

Education Qualification:*

Occupation:*

Prefered Training Center Location:*

Family details

Family Head's Name:*

Family Size:*

Family Occupation:*

Annual Income of Family:*

Documents

Disability Certificate (must be of type pdf, jpg/jpeg or png):*

Aadhar Card (must be of type pdf, jpg/jpeg or png):*