Vidya Prasarak Mandal’s POLYTECHNIC, THANE

‘Jnanadweepa’, College Campus, Chendani Bunder road, Thane – 400601.

Application Form
Higher Education Abroad for Polytechnic Students

VPM - Northern College of Applied Arts & Technology, Canada, Collaboration
Vidya Prasarak Mandal, Thane’s Collaboration Programme

Student Information : ( all * marked fields are compulsory )

Surname*
First Name*
Father's / Husband's Name*
Mother's Name*
Maiden Name
Parent Full Name*
Local Guardian Name 
Local Residence Address Line 1*
Local Residence Address Line 2*
Local Residence City*
Local Residence Pincode*
Local Residence Phone Number *
Mobile No.
Parent's Email ID
Family Annual Income
Student's Email ID*
Birth Date * (dd/mm/yyyy)
Gender * Male or Female
 Last School/College Attended
Educational Details
Class Passed In (Year) Board Ordinary / Technical Percentage  School
SSC
HSC
Qualification*
Diploma in Instrumentation Diploma in Electrical Engineering Diploma in Computer Engineering
Diploma Month and Year of Passing* format mm-yyyy example 03-2008
TOFEL /IELTS Score * ( minimum score 550 )
Passport Number* :
Passport validity From* :

Please verify the correctness of the data before clicking submit.