Title *

Full Name of Vice Chancellor *

University Name * -Select- [AGRA-DBRAU] Dr. Bhimrao Ambedkar University, Agra [AYODHYA-RMLU] Dr. Rammanohar Lohia Avadh University, Ayodhya [BAREILLY-MJPRU] Mahatma Jyotiba Phule Rohilkhand University, Bareilly [GORAKHPUR-DDU] Deen Dayal Upadhyaya Gorakhpur University, Gorakhpur [GORAKHPUR-MMTU] Madan Mohan Malviya University of Technology, Gorakhpur [JAUNPUR-VBSPU] Veer Bahadur Singh Purvanchal University, Jaunpur [LUCKNOW-KGMU] King George’s Medical University, U.P., Lucknow

Date of Birth *

Gender * --Select Gender-- Male Female Transgender

Email ID *

Mobile Number *