Registration Form

1. Full Name (Name and Surname)

2. Gender Select Female Male Other

3. Father’s Name and Surname

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 Name and Surname

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. Please mention the percentage / CGPA / Final Grade scored by you in Class X or Class XII

12. Name of the Educational Institute Select Padmabhushan Vasantdada Patil Institute of Technology Lokmanya Tilak College of Engineering Mahatma Gandhi Mission College of Engineering & Technology K. J. Educational Institute Trinity PDEA College of Engineering Government College of Engineering Chandrapur Shree L R Tiwari College of Engineering Universal College of Engineering Mahatma Gandhi Institute of Technical Education and Research Centre GIDC Degree Engineering College S.S. Agrawal Institute of Engineering and Technology Laxmi Institute of Technology Bhagwan Mahavir College of Engineering and Technology C. K. Pithawala College of Engineering and Technology Sarvajanik College of Engineering and Technology Shree Swami Atmanand Saraswati Institute of Technology R.N.G. Patel Institute of Technology Vidhyadeep Institute of Engineering and Technology Pacific School of Engineering Parul University ITM SLS Baroda University K.J. Institute of Engineering and Technology Sigma Institute of Engineering Babaria Institute of Technology Neotech Institute of Technology Merchant Engineering College Sardar Vallabhbhai Patel Institute of Technology, Vasad Madhuben and Bhanubhai Patel Institute of Technology Charotar University of Science and Technology (CHARUSAT) Dr. Jivraj Mehta Institute of Technology Sardar Patel College of Engineering Ipcowala Institute of Engineering and Technology G H Patel College of Engineering and Technology A D Patel Institute of Technology Swarrnim Startup & Innovation University Institute of Advanced Research IIIT Vadodara Shree Swaminarayan Institute of Technology Faculty of Engineering & Technology, The MS University of Baroda Karnavati University Ahmedabad Institute of Technology Silver Oak University Dharmsinh Desai Institute of Technology Navrachna University Guru Nanak Dev DSEU Rohini Campus DSEU Rajokri Campus Bhai Parmanand DSEU Shakarpur II Campus G.B. Pant DSEU Okhla I Campus Gujarat Technological University

13. State Select Andhra Pradesh Andaman and Nicobar Islands Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadar and Nagar Haveli Daman and Diu Delhi Lakshadweep Puducherry Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal N/A

14. Semester of Study (as applicable in July 2023) Select Semester 1 Semester 2 Semester 3 Semester 4 Semester 5 Semester 6 Semester 7 Semester 8

15. Branch of Study Select Diploma Computer Diploma in Electronics Engineering (Digital Electronics) Diploma Instrumentation and Control Diploma Electrical Diploma ECE MCA B. Tech (Mechatronics Engineering) B. Tech (CSE) B. Tech (MAE) B. Tech (ECE) IT Computer Science ICT Electrical Electronics and Communication Mechatronics Other – please mention

15-a. Other Branch Please Mention

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

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

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

19. What do you intend to do after completing your current degree/ diploma?

20. 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

21. Are you willing to contribute 200 hours of learning in program in next 8-9 months?
      Yes    No

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

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

24. 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

25. 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.