AIIMS Patna Student Management System

Student Registration Form

Student Information

Course Name*

SESSION*

Admission Date

Rank*

First Name*

Middle Name

Last Name*

Date of Birth*

Category*

Gender*

Nationality*

Religion*

Email Address*

Identification Mark*

Blood Group*

Father Name*

Mother Name*

Contact Details

Correspondance Address

State*

District*

Town/Village*

Police Station*

Pin*

Land Line

Mobile*

Street Adress*

Permanent Address Same as above

State*

District*

Town/Village*

Police Station*

Pin*

Land Line*

Mobile*

Street Adress*

Emergency/Local Guardian Contact

Guardian First Name*

Guardian Last Name*

Guardian Mobile No*

Relationship Type*

Guardian Address*

Educational Qualification

School Name*

State*

City*

Board*

Passing Year*

% of Marks*

Division*

Upload Imange*