SECTION 1: Student Profile Full Name (as per official ID) Date of Birth Age Gender MaleFemaleOtherPrefer not to say Blood Group A+A-B+B-AB+AB-O+O- Photo Upload Aadhaar Number SECTION 2: Contact Information Mobile Number (Student) Alternate Phone Number (optional) Email Address WhatsApp Number SECTION 3: Address Details 🏠Permanent Address House/Flat No. Street Name City District State Pincode Country 🏡 Current Address Same as Permanent Address House/Flat No. Street Name City District State Pincode Country SECTION 4: Parent/Guardian Information Full Name Relationship to Student FatherMotherGuardian Mobile Number Email Address Occupation Organization/Workplace Emergency Contact Number (if different) SECTION 5: Health & Emergency Info Known Medical Conditions Allergies Disabilities / Special Needs Emergency Contact Person - Name Relationship Phone Number SECTION 6: Preferences & Logistics T-Shirt Size XSSMLXLXXL Preferred Language for Sessions EnglishHindiOther Preferred Mode of Communication EmailWhatsAppPhone SECTION 7: Declarations & Consent I confirm that the above information is true and accurate.I consent to be contacted by the NEXIS team for official updates.I understand that any health information shared will be kept confidential and used only in case of emergency.I grant permission for photographs/videos taken during the program to be used for NEXIS communication and promotion.I agree to follow the rules and code of conduct of NEXIS. 🔒 Submit Your Application
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