Under Graduate Courses (BPTh., B.Sc.MLT)

Course applying for * Select BPTh. B.Sc.MLT

Other choices in the order of preferences : A. Select BPTh. B.Sc.MLT

  B. Select BPTh. B.Sc.MLT

Applicant's First Name *

Applicant's Last Name*

Caste / Category * Select SC ST OBC GENERAL

Nationality * Select INDIAN OTHER (SPECIFY)

If Other Please Specify

Permanent Address *

City

State * Select State Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttaranchal West Bengal Other

Pin Code

Tel

Mobile *

Tick Mark If Coorespondence Address is Same as Permanent Address

Correspondence Address *

Tel

Mobile *

E-mail

Date of Birth* - DAY - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - MONTH - January Febuary March April May June July August September October November December - YEAR - 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975

Father's Name *

Father's Occupation * Select Business Govt. Servent Others

Designation *

Contact No. *

Mother's Name *

Mother's Occupation* Select House Wife Business Govt. Servent Others

Designation *

Contact No. *

  Educational Qualification of applicant * Exam 10th

College/Institution

Board/University

Year

Subjects

Marks Obtained

Total Marks

%

  Educational Qualification of applicant* Exam 12th

College/Institution

Board/University

Year

Subjects

Marks Obtained

Total Marks

%

  Details of PCB marks(Physics, Chemistry & Biology)* A. Marks scored in Physics(including Practical Marks)

Marks Obtained

Total Marks

%

  B. Marks scored in Chemistry(including Practical Marks)

Marks Obtained

Total Marks

%

  C. Marks scored in Biology(including Practical Marks)

Marks Obtained

Total Marks

%

  Educational Qualification of applicant* Other

College/Institution

Board/University

Year

Subjects

Marks Obtained

Total Marks

%

Local Guardian's Name

Relation

Address

Tel

Mobile