Name of the candidate

:

      Father/Spouse Name

:

      Date of Birth

:

       Sex

:

Permanent Address

     Village and Panchayat

:

      Block / Tehsil

:

      District

:

      State

:

     PIN Code

:

       Address for Correspondence

:

Education Details

      Graduation

:

     University to which Affiliated

:

     Marks/Grade Obtained

:

     Year of Passing/completion

:

Contact details

     Current Location

:

     Telephone/Mobile

:

     Email

:

     Work Experience

:

Agri-Business interest

     Agriculture

:

     Other than agriculture

:

     Nature of enterprise being planned to set up after the training

:

     Experience in the enterprise being      planned

:

  Likely place of establishment of      enterprise

:

     Aptitude for extension work with      brief details of extension work done      and vision for future in serving      farmers.

: