APPLICATION FORM

Preview Form
PERSONAL DETAILS
Applicant's Full Name*
DHANRAJ CHANDRAKAR

Date of Birth*
03 October 2004

Gender*
Male

Country of Citizenship*
India

ID Type*
Aadhar Card

ID Number*
686144473981

Category*
Other Backward Caste Non-Creamy Layer (OBC-NCL)

Are you a Person with Disabilities (40% or more / “severe” where percentage is not defined)?*
No

CLASS 12 / EQUIVALENT DETAILS

Pass Status of Class 12 or Equivalent Exam*
Passed

Name of School*
DAVARA INTERNATIONAL SCHOOL BHELWADIH ABHANPUR RAIPUR CG

School Board*
Central Board of Secondary Education

Type of School*
Private

Country
india

State
Chhattisgarh

City
Raipur

CURRENT DETAILS
Total Work Experience*
Years0 Months0

Field of Work*
Select from list

Current Status*
Other

Other Current Status*

DROP FOR EXAM PREPARATION

CONTACT DETAILS
Alternate Email Address
dhanrajchandrakar720@gmail.com

Mobile Phone number*

+917415929246

Country*
India

State*
Chhattisgarh

City / Town / Village*

GOBRA NAWAPARA

House No., Building Name, Street Address*

153

Street Address Line 2

SHITLA PARA WARD NO 20

PIN Code*
493881

EXAM CITY OPTIONS

Exam City Preference 1
State*
Chhattisgarh
Select City of Preference*
Raipur

Exam City Preference 2

State*
Maharashtra
Select City of Preference*
Nagpur

ADDITIONAL DETAILS
How did you get to know about our program?*
Social Media

What is your goal if you clear qualifier exam?*

BS Degree in Data Science and Application

How many hours a week will you be able to spend on our courses?*
30 - 40 hours per week

What bandwidth internet do you use?*

4G

What device(s) do you use to access internet?*

Laptop
Tablet
Smart Phone

Are the devices mentioned shared with other users or your personal device?

Laptop
personal

Tablet
shared

Smart Phone
shared

Why do you want to join our program?*

Chance to get learn from a faculty of IIT Madras and to have great learning experience.

UPLOAD DOCUMENTS
Applicant’s Photograph*

Applicant’s Signature*

Applicant’s ID* CHECK UPLOADED DOCUMENT 

OBC-NCL Certificate* CHECK UPLOADED DOCUMENT 

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