ROOPIKA ACADEMY

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Student Admission Form

Select Your Institute *

Abbreviation*

Student Name*

Select One

Father / Husband Name

Surname

Mother Name

Course of interest*

Course Fees *

Minimum Amount To Pay *

Student Mobile *

Alternate Mobile

Email *

Date Of Birth *

Gender

State

City

Postcode

Permanent Address

Aadhar Card Number

Refferal Code (If Any)