1. Name(Use CAPITAL Letters)*:
2. Date of Birth*: Gender*: Male Female
3. Medium in which you propose to take the classes: English Hindi
4. Father's Name & Mob. No. *:
5. Father's Profession:
Permanent Address*:
(in CAPITAL letters)
PIN: Mobile:
Local Address*:
(in CAPITAL letters)
PIN: Mobile*:
7. E-Mail Address*:
8. Mention the batch/session in which you propose to take classes: Regular Classes Weekend Classes
9. Mention the course(s) you are enrolling for: GS Integrated Course Optional Subject
10. Education Qualification:
Name of Exam Year Subjects Board/University % of Marks Division/Rank Medium
Class XII
Post Graduation
Additional Qualification
11. Mention the year in which you have completed your last examination:
12. Optional subjects for the Main Exam:
13. Have you appeared in the Civil Services/PCS Examination earlier ? If yes, give complete details:
14. Family background in administration, if any:
15. Are you still a student? If yes, give details:
16. Are you employed? If yes, give details:
17. Mention the newspaper(s) you read:
18. Mention the magazine(s) you read:
19. Do you require hostel facility? Yes No
20. Has anybody recommended the Shiksha IAS Academy to you? If yes, tick appropraite box.
Parents Friends Teachers Newspapers Magazines Internet

I hereby undertake to obey and comply with all the rules & regulations of Study Circle, which I have read and
understood, in force from time to time.
I further declare that the particulars/information given by me in this form are correct to the best of my knowledge.

Date: Signature:

Note- The decision taken by the Shiksha IAS Academy on your above application shall be final and binding,