Title *

Full Name of Vice Chancellor/Director *

University/Institution Name * -Select- [KANPUR-CSMU] Chhatrapati Shahu Ji Maharaj University, Kanpur [KANPUR-HBTU] Harcourt Butler Technical University, Kanpur [LUCKNOW-SMNRU] Dr. Shakuntala Misra National Rehabilitation University, Lucknow [PRAYAGRAJ-RAJJU BHAIYA] Prof. Rajendra Singh (Rajju Bhaiya) University, Prayagraj [PRAYAGRAJ-UPRTOU] U.P. Rajarshi Tandon Open University, Prayagraj

Date of Birth *

Gender * --Select Gender-- Male Female Transgender

Email ID *

Mobile Number *