Registration – Pragathy Cyber Security

Name *

Guardian / Parent Name *

Email *

Confirm Email Address *

Mobile *

Gender *MaleFemaleOther

Age *

Do you belong to Scheduled Tribe *Select any one from the ListYes

Sub caste *Select any one from the ListAdiyanAranda (Arandan)EravallanHill Pulaya(Mala Pulayan, Kurumba Pulayan, Karavazhi Pulayan, Pamba Pulayan)Irular,IrulanKadar (Wayanad Kadar)Kanikkaran,KanikarKarimpalanKattunayakanKochuvelanKoragaKudiya,MelakudiKurichchan (Kurichiyan)Kurumans (Mullu Kuruman, Mulla Kuruman, Mala Kuruman)Kurumbas (Kurumbar, Kurumban)MahamalasarMalai Arayan (Mala Arayan)Malai PandaranMalai Vedan (Mala Vedan)MalakkuravanMalasarMalayan, Nattu Malayan, Konga Malayan (Excluding the areas comprising the Kasaragod, Kannur, Wayanad and Kozhikode Districts)MavilanMalayarayarMannan (to be spelt in Malayalam script in parenthisis)Muthuvan,Mudugar,MuduvanPalleyan, Palliyan, Paliyar, PalliyaPaniyanUlladan, UllatanUralyMala Vettuvan (in Kasaragod and Kannur Districts)Ten Kurumban, Jenu KurumbanThachenadan, Thachenadan, MoopanCholanaickanMalapanickarVettakuruman

Annual Income in lakhs *Please select an option0 – 10,00010,001 – 50,00050,001 – 1 lakhMore than 1 lakh

Qualification *Select any one from the ListGraduationPost-GraduationPhD

Subject Area *Select any one from the ListScienceEngineeringArtsOther

Specialisation *Select any one from the ListMathsITComputer ScienceOther

Percentage of marks in Degree *

Percentage of marks in 12th *

Percentage of Marks 10th *

District *Select any one from the ListAlappuzhaErnakulamIdukkiKannurKasaragodKollamKottayamKozhikodeMalappuramPalakkadPathanamthittaThiruvananthapuramThrissurWayanad

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

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I agree that all the information furnished above are true to the best of my knowledge. I will be willing the share necessary documentary evidences / proof for the information furnished above, to the competent authorities, at the time of selection process

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