APPLICATION FORM

Name of the Candidate :

Name of Father/Spouse        :

Date of Birth :

Sex: Male  Female

Permanent Address

Village and Panchayat :

Block and /or Tehsil :

District :

State :

Pincode :   

Address for Correspondence :

Educational Qualification

Name of the Degree/Diploma/Certificate/Course :

Specialisation :

Board/Institute/University where studied :

University to which Affiliated :

Marks/Grade Obtained :

Year of Passing/completion :

Contact details

Telephone with STD Code/Mobile :

Email :

Aadhar Card No. :

Name of the Bank :

Branch Name :

Account Number :

IFSC Code :

Experience (maximum 200 characters) :

Family Background

Agriculture :

Other than agriculture :

Agri-Business interest :

Nature of enterprise being planned to set up after the training (maximum 200 characters) :

Experience in the enterprise being planned :

Likely place of establishment of enterprise :

Aptitude for extension work with brief details of extension work done and vision for future in serving farmers. (maximum 200 characters) :