Candidate Name* :
   
DOB* :
   
Father's Name* :
   
Address* :
   
Contact No* :
   
Email* :
   
PCM % in 12th* : (Seperate % of Phy, Che, Math,Eng)
   
Board/School Name* :
   
Percentage/CGPA of 10th*:
   
UPSEE Roll No :
   
Combined UPSEE Rank:
   
UPSEE Category Rank:
   
Category :
   
Gender :
   
Other Rank : (Specify roll number and rank.)
   
Course :
   
Stream (Only for B.TECH Applicants):