JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
YUVAJANA REGISRATION CAMPAIGN
Sign in to Google
to save your progress.
Learn more
* Indicates required question
NAME
*
Your answer
ADDRESS
*
Your answer
PINCODE
*
Your answer
NAME OF FATHER
Your answer
NAME OF MOTHER
Your answer
THALUK
*
KOZHIKODE
QUILANDY
VADAKARA
THAMARASSERY
NAME OF LSGD/PANCHAYATH/MUNCIPALITY/CORPORATION
*
Your answer
NAME OF VILLAGE
Your answer
DATE OF BIRTH
*
MM
/
DD
/
YYYY
GENDER
*
Female
Male
Other:
CATEGORY
*
Choose
SC
ST
OTHERS
MINORITY
ARE YOU PWD(PERSON WITH DISABILITY)
*
YES
NO
WORKING IN MGNREGA
*
Choose
YES
No
IF YES GIVE MGNREGA NUMBER
Your answer
RATION CARD TYPE
APL
BPL
AAY
Clear selection
WHEATHER KUDUMBASHREE MEMBER OR FAMILY MEMBER
*
YES
No
RATION CARD NUMBER
*
Your answer
AADHAAR CARD NUMBER
*
Your answer
MARITAL STATUS
*
MARRIED
UNMARRIED
CONTAINS RSBY CARD
*
YES
No
IF YES RSBY CARD NUMBER
Your answer
HIGHEST QUALIFICATION IN SCHOOL EDUCATION
SSLC
+2
Clear selection
YEAR OF PASSING
Your answer
HIGHEST EDUCATION QUALIFICATION AND PASSING YEAR
Your answer
ARE YOU INTERESTED WORKING IN
OTHER DISTRICT
OTHER STATE
ABROAD
Other:
Clear selection
AREA OF INTEREST TO WORK
*
Your answer
mobile number
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
