Registration Form

1. Full Name (Name as per Aadhar Card)

2. Gender Select Female Male Other

3. Father’s Full Name

4. Mobile Number

5. Email ID

6. Father’s Occupation Select Self Employed – Business Self Employed – Professional Employed with the Private Sector Employed with the Government Unemployed Other

7. Mother’s Full Name

8. Mother’s Occupation Select Self Employed – Business Self Employed – Professional Employed with the Private Sector Employed with the Government Unemployed Other

9. Category Select General SC ST OBC Other

10. Please mention your annual family income Select Less than 2 lakhs per annum Between 2L and 5L per annum Between 5L and 8L per annum Between 8L and 10 lakhs per annum Above 10 lakhs per annum

11. Kindly specify your percentage/CGPA/final grade obtained in Class X

12. Kindly specify your percentage, CGPA, or final grade obtained in Class XII

13. State Select Gujarat Karnataka Maharashtra Telangana

14. Name of the Educational Institute Select

15. Name of the Degree: Select BE/B.Tech ME/M.Tech MCA

16. Year of Study: Select 2nd year 3rd year 4th year

17. Current Semester of Study: Select Semester 1 Semester 2 Semester 3 Semester 4 Semester 5 Semester 6 Semester 7 Semester 8

18. Branch of Study Select Computer Science Information Technology Artificial Intelligence/Machine Learning Electronics and Communication Electrical Other – please mention

18-a. Other Branch Please Mention

19. Which academic subject from your current diploma/degree course do you find interesting? (You can mention more than one.)

20. Please mention the skills you are interested in learning alongside your current courses

21. Are you pursuing any other courses apart from those offered by your Institute? If yes, please mention the same

22. What do you intend to do after completing your current degree/ diploma? Select Job Higher studies Go abroad Business Government job

23. What is your expectation from the Code Unnati Program? You can check more than one boxes from the following:

• For better internship and employment opportunities
• To get a skill certification
• To learn new skills
• To work on a live project
• To get mentorship support from qualified faculty members

24. Are you willing to contribute 90 - 125 hours of learning in program in next 8-9 months?
Yes    No

25. Please check the option applicable in your case Select I access a computer through your institute I have a personal computer / laptop

26. How did you come to know about this training program?
College Faculty
Social Media
Friends/classmates
College Seniors
Edunet Foundation -Orientation Session
College Notice board

27. Please rate yourself on coding skills
I - C Language
5 = High level of competence
4 = Moderately high level of competence
3 = Average level of competence
2 = Low level of competence
1 = No level of competence

II- Python
5 = High level of competence
4 = Moderately high level of competence
3 = Average level of competence
2 = Low level of competence
1 = No level of competence

28. Please rate your English Language skills
5 = High level of competence
4 = Moderately high level of competence
3 = Average level of competence
2 = Low level of competence
1 = No level of competence

I agree that above information is complete and correct. The Code Unnati Program team can connect with me through phone or email for program related communication in future.