PRERANA Registration Form

Full Name of the Student *

Date of Birth *

Gender *

Class *

Email ID of student *

Mobile Number of student/parent *

School Board *

Please Specify your school Borad *

Category *

Children with Special Need (CWSN) *

State *

District *

School Name *

Please specify School Name *

Pin Code *

Location of School *

Special Talent-1 *

Please Specify Talent *

Talent Level-1

Talent Position-1

Talent Position-1

Special Talent-2

Please Specify Talent

Talent Level-2

Talent Position-2

Talent Position-2

Special Talent-3

Please Specify Talent

Talent Level-3

Talent Position-3

Talent Position -3

Special Talent-4

Please Specify Talent

Talent Level-4

Talent Position-4

Talent Position -4

Medical issue (if any)

Name of Principal

Mobile Phone Number of Principal

Email Id of School *

Who is your Role Model and Why?

Enter Captha Code *

Captha Code

I confirm that the above given details are genuine. *