UG Reg No

Photo: (Upload JPG,PNG and GIF Image Only)

Course Applied for

  M.Sc Medical Lab Technology  

Name of Applicant

Expansion of Initial

E-mail

Date of Birth

 

Nationality

Mobile No

Community

Select OC BC MBC/DNC SC/ST Others

Religion & Community Name

Sex

Select Male Female Transgender

Physical Condition

Select Normal Disabled  

Mother Tongue

Blood Group

Details of Parents/Guardian

DETAILS	FATHER	MOTHER
NAME
QUALIFICATION
ADDRESS FOR COMMUNICATION
PHONE NO
EMAIL ID
ANNUAL INCOME

Name of the Degree

Name of the College & Address

Medium of Instruction

UG Main Subject

University to which college is affiliated

Select The Tamilnadu Dr.MGR Medical University Bits pilani Madras University Others  

Extra Curricular Activities participated Sports / NSS / NCC / Others (Specify):

Details of Marks Obtained:

	1stYear	Marks Obtained	2ndYear	Marks Obtained	3rdYear	Marks Obtained
Subject I
Subject II
Subject III
Subject IV
Subject V
Subject VI
Subject VII
Subject VIII
Percentage
Total

Amount :

₹1000

    I hereby declare all the above information are true to the best of my Knowledge.