mLAC - Online / Offline Application form for Academic year 2024-25
Application Number
[Auto generated]
1. General Details of Applicant
Applicant Name
(As per SSLC Marks Card)
Gender
Female
DOB
(As per SSLC Marks Card)
Domicile state
KARNATAKA
ANDAMAN & NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA & NAGAR HAVELI
DAMAN & DIU
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU & KASHMIR
JHARKHAND
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
NCT OF DELHI
ODISHA
PUDUCHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
Student Type
Karnataka State Board
CBSE Board
ICSE Board
Other State
Nationality
Religion
Category
1
2 A
2 B
3 A
3 B
GM
SC
ST
Sub-caste
Aadhaar Number
Physically Challanged
No
Yes
Student Mobile No
Mother tongue
Email ID
Address
Address Pincode
2. Details of Parents / Guardian
Father Name
(As per SSLC Marks Card)
Qualification
Select
Doctoral studies/ Ph.D
Post-Graduate/Master’s Degree
Graduate/ Bachelor’s Degree
Diploma
Completed 10+2
Completed SSLC / Class 10
Completed Primary Education
None
Not attended School
Attended School
Any other
Occupation
Annual Income
Mother Name
Qualification
Select
Doctoral studies/ Ph.D
Post-Graduate/Master’s Degree
Graduate/ Bachelor’s Degree
Diploma
Completed 10+2
Completed SSLC / Class 10
Completed Primary Education
None
Not attended School
Attended School
Any other
Occupation
Annual Income
Guardian Name
Qualification
Select
Doctoral studies/ Ph.D
Post-Graduate/Master’s Degree
Graduate/ Bachelor’s Degree
Diploma
Completed 10+2
Completed SSLC / Class 10
Completed Primary Education
None
Not attended School
Attended School
Any other
Occupation
Annual Income
Parents/Guardian Address (
same as Applicant Address )
Pincode
Parents/Guardian Mobile No
3. Academic details
Course Type
PU
Course Name
Select
Combination
Select
Second Language
KANNADA
HINDI
ADDITIONAL ENGLISH
SANSKRIT
Qualifying Exam Board
SSLC (Karnataka State board)
SSLC (Other State board)
Class X ICSE
Class X CBSE
NIOS
Marks Scored
Total Marks
Percentage
Previous Reg No
Passing Year
Applicant Studied at mLAC?:
Previous College Name
Referral Type
None
Student
Alumni
Referred By
If referred by student, register number
Alumni Course
Alumni Graduation Year
Additional Info
Name as in Aadhar
Blood Group
Select
A+
A-
B+
B-
O+
O-
AB+
AB-
Height (Feet)
Weight (Kg)
Percentage of disability
Scholarship Availed
Select
State
Central
Any other Trust
Admission Number I PU
Admission Number II PU
Minority
Select
YES
NO
BPL beneficiary
Select
YES
NO
BPL beneficiary number
Previous Year Attendance (%)
Previous Year Percentage (%)
Interest In extracurricular
Participation in Sports
Sports
|
NCC
|
NSS
|
Scouts
|
Interest in science
Science
|
Arts
|
Sports
|
Lang
|
Technical
|
Maths
|
Select
Select