Registration Form

1. Full Name (Name required on Certificate)

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. State Select Delhi Gujarat Maharashtra Telangana

13. Name of the Educational Institute Select

14. Year of Study: Select BE/BTech 2nd year Prefinal year Final year

15. Semester of Study (As per academic year 2024-25): Select Semester 1 Semester 2 Semester 3 Semester 4 Semester 5 Semester 6 Semester 7 Semester 8

16. 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

16-a. Other Branch Please Mention

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

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

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

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

21. 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

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

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

24. 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

25. 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

26. 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.