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Full Name *
DOB *
Gender *
Male
Female
Other
Phone Number *
Email *
Taluka *
Select Taluka
Village *
Select Village
Current Address *
University Name *
Enrollment Number *
Current Academic Level *
Select level
Year of Study *
Select year
Preferred Language *
Select language
Emergency Contact Name *
Relationship *
Select Relationship
Emergency Contact Number *
Do you have prior experience in sales or fieldwork? *
Yes
No
Farming Background *
Yes
No
Fieldwork Area *
Are you available to work during the entire program duration (3 - 6 months)? *
Yes
No
Do you have any medical conditions or physical limitations that may affect your participation? *
Yes
No
Transportation Availability *
I have my own transport
I will use public transport
Are you comfortable interacting with farmers? *
Yes
No
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