Enquiry Form Student Details Candidate Name: SRMDC102 Date of Birth: << Year >> January February March April May June July August September October November December Su Mo Tu We Th Fr Sa Gender: Male Female Address for Communication: Address Line 2: City: Pincode: State: --Select-- Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttaranchal Uttar Pradesh West Bengal Email Id: Mobile: Landline: Parents Details Father Mother Name: Occupation: --Select-- Business Salaried-Private Salaried-State Salaried-Central Others --Select-- Business Salaried-Private Salaried-State Salaried-Central Others Designation: Email Id: Mobile Number: Academic Details School / College Name: Medium of Study: --Select-- Tamil English Hindi Telugu Malayalam Kannada Board of Examination: --Select-- State Matriculation CBSE ICSC Intermediate Degree: --------Select-------- Under Graduate Post Graduate Courses: Percentage of Mark: 10th 12th Under Graduate Hostel Needed: Yes No Transport Needed: Yes No How do you know about SRMDC --Select-- Newspaper Television Magazines Websites Friends Brochures Note : This is online enquiry form only, admission will be processed with respect to Consortium. Reset