Reception Registration Form

Name

Email

Contact Number

+91

Date of birth

Gender

– Select –MaleFemale

Marital Status

– Select –UnmarriedMarried

Any Refusal

Yes

No

If yes, Which Country?

Parents Profession

Course

– Select –SSC 10thHSC 12thGraduationPost GraduationAny Other

Stream

School/College

Board/University

Percentage

Completion Year

Course

– Select –SSC 10thHSC 12thGraduationPost GraduationAny Other

Stream

School/College

Board/University

Percentage

Completion Year

Course

– Select –SSC 10thHSC 12thGraduationPost GraduationAny Other

Stream

School/College

Board/University

Percentage

Completion Year

Course

– Select –SSC 10thHSC 12thGraduationPost GraduationAny Other

Stream

School/College

Board/University

Percentage

Completion Year

Work Experience

Yes

No

Company Name

Designation

From (start year)

To (End year)

Experience years

Preferred Country

Canada

Australia

US

UK

Europe

Germany

Singapore

Dubai

Japan

Preferred Cities

Preferred Cities

Interested Course of study

Preferred Institute

Have you applied to any college/university?

Yes

No

Have you given IELTS/PTE/Toefl/Duolingo

Yes

No

Which one?

– Select –IELTSPTEDuolingoTOEFL

Test Date

Overall Band Score

Reading

Writing

Listening

Speaking

How did you get to know about us?

– Select –NEWS PaperFlyer/PosterFacebookInstagramWebsiteGoogleAny Reference

For Official Work

---

Counselor Name

Ein No.

Submit