Name  *

Mobile Number *

Whatsapp Number *

Email ID *

Gender *

Age * Choose Age 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

Educational qualifications * Select Your Educational qualifications Below 10th Standard 10th Standard 12th Standard Graduate Post Graduate

What is the name of your University? *

Which course were you enrolled in? * Please Select your Course B.A. B.Com/BBA B.Sc B.Tech M.A M.Sc

Occupation * Choose Your Occupation

What is your occupation from the following? Choose Your Occupation Shopkeeper Contractor Farmer Business Other

Which category do you belong to? * Choose Category Don’t want to mention GENERAL OBC SC ST EBC

State * Select State

District * Select District

Assembly Constituency * Select Assembly Constituency

Do you reside in a village or a city? *

Block Select Block

Name of your Gram Panchayat? Select Gram Panchayat

City Name Select City

Are you associated with any party, currently? * Choose Party

Are you a party post holder? Select your position District President District Vice President District Secretary District General Secretary Block President Block Vice President Block Secretary Block General Secretary Frontal District President Frontal District Vice President Frontal District Secretary Media Cell Booth Worker Other

Which is your preferred state for the fellowship programme? * Please Select State Any State

When would you like to begin the fellowship? *

Do you have a two wheeler vehicle? * Yes No

Do you have a smartphone? * Yes No

Do you have a laptop? * Yes No

What would be your preferred language? *