Application for Admission - UG Courses
Should have Completed 17 Years Before August 2026
+2 Reg No
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* Please Select One Course
Course Applied for
Bachelor of Physician Associate (BPA)
Bachelor of Anaesthesia & Operation Theatre Technology (B.AOTT)
Bachelor of Medical Laboratory Science (BMLS)
Bachelor in Dialysis Therapy Technology (BDTT)
Bachelor of Medical sociology
Bachelor of Cardiac care technology
Bachelor of Cardio pulmonary perfusion technology
Name of Applicant
Expansion of Initial
E-mail
Date of Birth
Nationality
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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
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CBSE
State Board
ISC
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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
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2
3
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8
9
10
English
Select
100
200
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9
10
Subject I
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100
200
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9
10
Subject II
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100
200
1
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8
9
10
Subject III
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100
200
1
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8
9
10
Subject IV
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100
200
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8
9
10
Subject V
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100
200
1
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8
9
10
Subject VI
Select
100
200
1
2
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5
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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.
