ANTI RAGGING UNDERTAKING BY STUDENTS AND PARENTS/GUARDIANS

BHILAI INSTITUTE OF TECHNOLOGY, RAIPUR

ANTI RAGGING UNDERTAKING BY STUDENTS AND PARENTS/GUARDIANS

Fields marked with red* are compulsory.

Personal Details

Student's Family Name *
Student's Middle Name
Student's First Name*
Gender* Male Female Other
Nationality*
Student's Mobile Number*
Student's friends Mobile number in case of emergency*
Landline Number
Student's email ID*
Confirm Student's email ID*
Permanent Address1*
Address2
City*
State*

Parent/Guardian's Details

Parent/Guardian's name*
Parent/Guardian's Address1*
Address2
City*
State*
Residence Phone No
Mobile No of Parent/Guardian*
Parent/Guardian's email ID

College Details

State in which the college is*
Is it a Professional College or a General College*
Name of the college*
Name of Affiliated University*
It is Deemed University* Yes No
Director/Principal Title*
Director/Principal Family Name*
Director/Principal First Name*
Director/Principal Gender* Male Female Other
College Phone No.1*
College Phone No.2
Nearest Police station Name and Address*

Course Details

Under Graduate or Post Graduate*
Name of the Course*
Your Registration/Enrolment Number/College ID
How many students are in your Class*
Year of Study*