Application for Admission - UG Courses
Should have Completed 17 Years Before October 2023
+2 Reg No
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Course Applied for
B.Sc Medical Sociology
B.Sc Dialysis Technology
B.Sc Medical Lab Technology
* Please Select Maximum Two Courses Only
Name of Applicant
Expansion of Initial
E-mail
Date of Birth
Nationality
Mobile No
Community
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OC
BC
MBC/DNC
SC/ST
Others
Religion & Community Name
Sex
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Male
Female
Transgender
Physical Condition
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Normal
Disabled
Mother Tongue
Blood Group
Details of Parents/Guardian
DETAILS
FATHER
MOTHER
NAME
QUALIFICATION
ADDRESS FOR COMMUNICATION
PHONE NO
EMAIL ID
ANNUAL INCOME
Details of School Last Studied:
Name
Address
Medium of Instruction
Board
Select
CBSE
State Board
ISC
Others
Extra Curricular Activities participated Sports / NSS / NCC / Others (Specify):
Details of Marks Obtained: 12th Standard:
Subject
Marks Obtained
Max Marks
Month/Year of Passing
No of Attempts
Language
Select
100
200
1
2
3
4
5
6
7
8
9
10
English
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject I
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject II
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject III
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject IV
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject V
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject VI
Select
100
200
1
2
3
4
5
6
7
8
9
10
Total
OUT OF
Reason for choosing this course
Amount :
₹1000
I hereby declare all the above information are true to the best of my Knowledge.
