Scholarship Form Student's First Name * Middle Name Last Name * Mother's Name * Personal Details Gender * –Select– Male Female Other Date of Birth * Day Select day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Select month 1 2 3 4 5 6 7 8 9 10 11 12 Year Select Year 2123 2122 2121 2120 2119 2118 2117 2116 2115 2114 2113 2112 2111 2110 2109 2108 2107 2106 2105 2104 2103 2102 2101 2100 2099 2098 2097 2096 2095 2094 2093 2092 2091 2090 2089 2088 2087 2086 2085 2084 2083 2082 2081 2080 2079 2078 2077 2076 2075 2074 2073 2072 2071 2070 2069 2068 2067 2066 2065 2064 2063 2062 2061 2060 2059 2058 2057 2056 2055 2054 2053 2052 2051 2050 2049 2048 2047 2046 2045 2044 2043 2042 2041 2040 2039 2038 2037 2036 2035 2034 2033 2032 2031 2030 2029 2028 2027 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 Age * Occupation Category * Non Creamy-layer * –Select– Yes No Domicile * Physically Handicapped * –Select– Yes No Ex Serviceman * –Select– Yes No Annual Income * Current Address * District * Taluka / City * State * ZIP * Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Australia Aruba Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cabo Verde Cayman Islands Central African Republic Chad Chile China, People’s Republic of Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French South Territories Gabon Gambia Georgia Germany Guernsey Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Island Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Johnston Island Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kosovo Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau North Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Island Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa Saint Helena Saint Pierre & Miquelon San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and South Sandwich Spain Sri Lanka Stateless Persons Sudan Sudan, South Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan, Republic of China Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom US Minor Outlying Islands United States of America (USA) Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis And Futuna Islands Western Sahara Yemen Arab Rep. Yemen Democratic Zambia Zimbabwe Mobile Number * 0 / 10 Email Address * Invalid email address. Whatsapp Number * 0 / 10 Parent’s Mobile No. * 0 / 10 Course Details Applying for Course * –Select– UPSC MPSC Weekend UPSC Batch Weekend MPSC Batch Optional CSAT Medium of Course * –Select– English Marathi Optional Subject Education Qualification Educational qualifications for Higher (12th) Year –Select Year– 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Board/University/College Marks Percentage/CGPA Subjects / Stream Educational qualifications for Graduation Year –Select Year– 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Board/University/College Marks Percentage/CGPA Subjects / Stream Competitive Exam Attempts (If any) –Select– UPSC MPSC Others No Year –Select Year– 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 How Did you come to know about RIIM Academy? 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