Pradhan Madam Academy for NEET & JEE in Nagpur, India

Please fill all the details correctly in all sections

Select Course *:

First Name *:

Middle Name *:

Last Name *:

Mother's Name:

Communication / Mobile No *:

Parent's Mobile No *:

Date of Birth:

Gender :

Caste Category :

Email Address *:

Parent Email Address :

Postal Address *:

City *:

Pin Code:

Upload Photo:

Name of School *:

(Please select your school name from the dropdown. If it's not listed, choose "Other" and enter your school's name.)

Previous Std Percentage :

Board:

I hereby declare that all particulars stated in this Enrollment Form are true and correct to my knowledge & belief.

Rules & Regulations.

PMA - Online Admission Form