Student Name *

Student Phone No *

Student Email *

Gender *
FemaleMale

Date of Birth *

Marital Status *
SingleMarried

Category *
GeneralSCSTOBC

Course Applied For *
Diploma in Medical Lab TechnologyB.Sc in Medical Lab TechnologyDiploma in Radiology & Imaging TechnologyB.Sc in Radiology & Imaging TechnologyDiploma in Critical Care TechnologyB.Sc in Critical Care TechnologyDiploma in Operation Theatre TechnologyB.Sc in Operation Theatre TechnologyDiploma in Neuroscience TechnologyB.Sc in Neuroscience TechnologyDiploma in Cardiac Care TechnologyB.Sc in Cardiac Care TechnologyDiploma in Physician AssistantB.Sc in Physician AssistantDiploma in Hospital ManagementB.Sc in Hospital ManagementDiploma in PhysiotherapyB.Sc in PhysiotherapyDiploma in OptometryB.Sc in Optometry

Father’s Name *

Mother’s Name *

Guardian Phone No *

Permanent Address *

Last Qualification with Marks Obtained *

Hostel Facility Required *
YesNo

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