+2 Reg No

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Course Applied for

B.Sc. Medical Sociology

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DETAILS	FATHER	MOTHER
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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.