Candidate Registration

Name*	Mobile 1*	Mobile 2
E-Mail 1*	E-Mail 2	Gender* Male Female
Date of Birth*	Fathers Name*	Mothers Name*
Address	City	State
Over All 10 Percentage	10 Year Of Passing	10 Board
Over All 12 Percentage	12 Year Of Passing	12 Board
Diploma Percentage:	Diploma Degree Name:	Diploma Year Of Admission:
Diploma Year Of Passing:	Diploma College Name:	Diploma University:
Diploma Backlogs If Any:	UG Degree Percentage:	UG Degree Name:
UG Degree Year Of Admission:	UG Degree Year Of Passing:	UG Degree College Name:
UG university:	UG Degree Backlogs If Any:	PG Degree Percentage:
PG Degree Name:	PG Specilization:	PG Degree Year Of Admission:
PG Degree Year Of Passing:	PG Degree College Name:	PG University:
PG Degree Backlogs If Any:

Bhilai Campus

Rungta Educational Campus
Khoka-Kurud Road, Bhilai - 490024, Chhattisgarh, India

[email protected]

92291-55531 , 92291-55542

Raipur Campus

Rungta Educational Campus
Veer Savarkar Nagar, Near Nandanvan, Raipur - 492099, Chhattisgarh, India

[email protected]

92291-55531 , 92291-55542

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