P.F.S. No.

Centre.
Date
Centre Code

Personal Fact Sheet

Please make all entries in BLOCK LETTERS

Name
Parents/Guardians Name
Address
Date of Birth

SEX

Phone
Pin Code

Medium : Hindi / English

Please 3 the Appropriate Block

Discipline
10th
12th
Graduation
Post Graduation
MBA & Others

Field/ Stream
Art
Commerce
Science
Computer Science

I Have Secured
4 0% o r l e s s

Nature of Job
Employed

41 to 50 %
51 to 60 %
61 to 70 %

Self Employed
Un Employed

71 to 80 %
8 1% or more

Studying.

Mode of References
Advertisement of MIFSE seen in newspaper/Magazine._____________________.(Name of newspaper/magazine)
Advertisement of MIFSE seen on Cable TV_____________________________(Mention Program Name)
Poster or Banner of Hoarding MIFSE _______________________________________
Letter received from MIFSE ______________________________________________
Representative of MIFSE _______________________________________(Name of the Representative)
Presentation of MIFSE _________________________________________
Recommendation of someone in the Institute/ Facilitation Centre __________________________________
Specify___________________________________________________________________________
Interested In:Morning Batch/ Afternoon Batch/ Evening Batch

COURSE RECOMMENDED___________________________________________________________
TO BE CONTACTED AGAIN ON DATE__________________________________________________
REGISTRATION ON________________________________________________________________
REMARKS_______________________________________________________________________

COUNSELOR SIGNATURE