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|^| Institute of Environment & Management, Online Application
--------------------------------------- Online Application Form ---------------------------------------

Course Applied for *

Name( in block letters)*

Father's Name*

Mother's Name *

Occupation *

Permanent Address *

Pin Code  *


STD           Phone No.  

Mailing Address


Date of Birth *


Whether you belong to

Academic & Professional Qualification : (Start With High School)
School / College Exam passed Year Subject % of Marks
Instructions to the candidate:
(a) Admission to each course shall be made on the basis of UPTU/AICTE rules whichever is applicable.
(b) Attested copies of the mark sheets of qualification.
(c) Fee once deposited is not refundable to any circumstances.
(d) Dispute if any will subject to under jurisdiction of Lucknow only.