Jnana Prabodhini's Institute of Psychology (JPIP)

Application Form for Admission to the 2022-2023

1. Candidate's Personal Information

First Name :* Maiden Name: Father's/Husband's Name:* Last Name:* Mother Name:* Date of Birth:* Birth Place: Gender: * Male Female Trans Gender Blood Group: Choose blood group...AB+AB-A+A-B+B-O+O-   Choose blood group... AB+ AB- A+ A- B+ B- O+ O- Nationality:* Religion :* HinduMuslimJainChristianSikhNavboudhParsi   Hindu Muslim Jain Christian Sikh Navboudh Parsi Category:* Choose Category..OpenOBCSBCSCSTDTA/VJNTNTBNTCNTDDefencePhysically HandicappedFreedom Fighter HeirDTNT-ADTNT-BDTNT-CDTNT-DOther Than SPPU   Choose Category.. Open OBC SBC SC ST DTA/VJNT NTB NTC NTD Defence Physically Handicapped Freedom Fighter Heir DTNT-A DTNT-B DTNT-C DTNT-D Other Than SPPU Caste: * Choose Caste..BrahminCKPDhangarKumbharLingayatMaliMarathaMaharSonarOther   Choose Caste.. Brahmin CKP Dhangar Kumbhar Lingayat Mali Maratha Mahar Sonar Other Domicile/State:* Choose state...Andaman and Nicobar IslandsAndhra PradeshArunachal PradeshAssamBiharChandigarhChhattisgarhDadra and Nagar HaveliDaman and DiuDelhiGoaGujaratHaryanaHimachal PradeshJammu and KashmirJharkhandKarnatakaKeralaLakshadweepMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPondicherryPunjabRajasthanSikkimTamil NaduTripuraUttar PradeshUttarakhandWest Bengal   Choose state... Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Copy Local Address Local Address:* Permenant Address:* District:* District:* Taluka:* Taluka:* Pincode:* Pincode:* Aadhar Card Number: Voter Id: Relevant Experience :

Upload Image: Choose Maximum Image Size should be 1MB

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2. Parent's Information

Note* : In case the Mother/Father doesn't have a middle name, please put '-'.

Full Name:*
Father's/Husband's Occupation :*	Service Business Retired	Annual Income (Rs.):*	Rs. 0 - Rs. 2,00,000 Rs. 2,00,001 - Rs. 4,00,000 Rs. 4,00,001 - Rs. 6,00,000 Rs. 6,00,001 - Rs. 8,00,000 > Rs. 8,00,001 Kindly Submit supporting document to show Annual Income at the time of admission
Office Name and Address :

3. Contact Details

Landline :		Student Mobile no. :*
Student's Email-ID :*
Father's/Husband's Mobile no. :*		Father's/Husband's Email-ID :
Mother's Mobile no. :		Mother's Email-ID :

4. Documents To Be Uploaded

* Upload 10th Marksheet	-	* Upload 12th Marksheet	-
* Upload Degree Marksheet	-	* Upload Degree Certificate	-
Upload Leaving/Transfer Certificate	-	Upload Migration Certificate	-
Upload Gap Certificate	-	Document of Name Change (if applicable)	-
Upload Caste Certificate (if applicable)	-	Upload Experience Certificate	-

	The Information given is true to the best of my knowledge and belief

Submit