Enquiry Form

STUDENT'S NAME

DATE OF BIRTH (DD/MM/YYYY)

PREVIOUS SCHOOL NAME (IF ANY)

MOTHER'S NAME

FATHER'S NAME

FULL ADDRESS (IN CAPITAL LETTERS)

PHONE NUMBER (Mobile/Landline)

Email

FATHER'S Occupation

FATHER'S QUALIFICATION

MOTHER'S Occupation

MOTHER'S QUALIFICATION

FAMILY INCOME (YEARLY)

HOW DO YOU KNOW ABOUT OUR INSTITUTION (advertisement / NEWS PAPER / FRIEND'S / STUDENT'S / INTERNET / PARENT'S / OTHER SOURCES)

YOUR VIEWS TOWARDS OUR INSTITUTION CHOOSE FROM THE FOLLOWING

EXCELLENT GOOD BETTER AVERAGE POOR

SAMRIDDHI Institute of Health & Technology