Course Registration Form

SRI JAGADGURU RENUKACHARYA PRE-UNIVERSITY COLLEGE #9, Race course Road , Bengaluru-560 009
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Father's Name*
Mobile Number *
Mother's Name*
Mobile Number *
Courses Offered
Note: Fee concession for Meritorious students, National & State level players
First Language *

KannadaSanskritHindi
National &High school Education
Name of the school last attended*
Year of passing 10th exam*
Board*

StateCBSEICSEIGCSE
Total Marks obtained*
Percentage (%)*
Medium of instruction *
Marks card*

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Upload Caste Certificate*

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Upload income certificate*

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Take Photo*
Mother Tongue*
Place of Birth*
Aadhar Number*
Religion *
Caste*
Category*
Signature*

Clear
For further details contact Manjula S Principal 080-2220 7469 91080 23317 94827 11062
Admission Incharge

Manjula S 94827 11062 Rajshekar M 83104 24301
Should be Empty:

National &High school Education