GP BIRLA

G P BIRLA SCHOLARSHIP ONLINE APPLICATION FORM

Last Date for receipt of application: 20-02-2025

Name of the Applicant *

Applicant Photo *

Date of Birth *

Gender *

Male

Female

Other

Address *

City/Town/Village *

City

Town

Village

State *

PIN *

Mobile No. *

Email *

Name of Father *

Father's Photo *

Contact No. *

Occupation *

Annual Income *

Name of Mother *

Mother's Photo *

Contact No. *

Worker *

Home Worker

Workers

Exam Board*

Photo *

Passing Year *

Marks Obtained (%) *

Rank Obtained *

Name of School Last Studied *

A brief resume of the applicant including particulars of extracurricular activities

Subject of Further Studies*

Photo *

Course Duration (in years)*

Name of the Institute where the applicant will pursue further studies.*

Address of the Institute where the applicant will pursue further studies.*