Admission Form

A) GENERAL INFORMATION

Select Program: -- Select Program --B.Sc. Cyber SecurityB.Sc. Data ScienceM.Sc. Cyber SecurityM.Sc. CAM.Sc. BioinformaticsB.SC. ITB.SC. Al & MLB.SC. CSB.SC.CDSB.SC. CAB.SC.DSName: Contact Email: Contact No.: Alternate Contact No.: Adhar Card No: Blood Group: Date of Birth: Age (as on 1st July 2020): Gender: -- Gender --MaleFemaleOtherNationality: Religion: Father / Guardian’s Name: Professional Background (Father/Guardian): Designation (Father/Guardian): Mobile No (Father/Guardian): Residence No. (with STD Code): Mother’s Name: Professional Background (Mother): Designation (Mother): Email Id (Parents): Alternate Email Id (Parents): Family’s Yearly Income: Sources of Income: Do you have any Brother(s)/Sister(s)? If yes, their names & occupation:

B) POSTAL ADDRESS

Communication Address: Country: State: City: Pincode: Permanent Address: Country: State: City: Pincode:

C) DETAILS FOR FOREIGN STUDENTS

Passport No.: Passport Issued: Valid Till: Visa No.: Visa Type: Valid Till: Nationality: Country: Any Relative in Pune / India: Relationship: Contact No.: Email Id: Address: University Exam Given:

D) ACADEMIC DETAILS

10th Board Exam:
12th Board Exam:
Diploma (if any):
Graduation:
Any Other:
Computer Literacy:

E) INDUSTRY WORK EXPERIENCE (If Any)

Experience 1:
Experience 2:

F) EXTRA-CURRICULAR ACTIVITIES

Activity 1:
Activity 2:
Languages Known: EnglishHindiOtherHobbies & Interests: Strengths & Areas of Improvement: Why do you think SURYADATTA is the best option for you? Health Records:

G) OTHER DETAILS

Category: Gen/OpenSCSTOBCSBCVJ/NTSEBCJain MinorityOthersAttach Non Creamy Layer Certificate? YesNoAttach Domicile & Nationality Certificate? YesNoPhysically Handicapped Candidate? YesNoOutstanding Performer in Academics? YesNoGap in Education? YesNoSource of Information: NewspaperMagazineInternetAlumniCurrent StudentsParental ReferenceOther Hostel Facility: -- Select Option --Only BoardingBoarding & MessNoPreferred Mode of Payment: Own SourceEducation Loan

Documents to be submitted (Upload Copies):

H) RULES & REGULATIONS

Read Rules & Regulations (Click here)

I) DECLARATION

I confirm that the above information is correct and I have read all rules and regulations. [acceptance* declaration] I Agree