Paramedical Application Form

Paramedical Programme (2013-17)

     
Application No :
Name of the Applicant *
(In BLOCK letters as entered in 10th standard certificate)
:
Father's Name *
(In BLOCK letters)
:
Mother’s Name *
(In BLOCK letters)
:
Occupation of the Parent * :
Annual family income :
     
Permanent Address : *

Taluk * :
District * :
State * :
Pin Code * :
Phone No. with STD code * :
 
Address for Communication : *

Taluk * :
District * :
State * :
Pin Code * :
Phone No. with STD code * :
     
Email * :
Mobile * :
Age & Date of Birth * :   
Religion * :
Caste :
Sub Caste :
Name of the School Studied for SSLC * :
Year of passing & Reg No. :   
     
Qualifying Exam Marks(+2/ICSE/CBSE/VHSE) * CET Marks *
Board Subjects % of Total Entrance Roll No. Paper I Paper II Entrance Rank

Biology Physics Chemistry







     
Name of the school studied for Plus Two * :
Reg No. * :
No. of attempts :
Year of Passing * :
Whether applied under
Merit/Management/NRI Quota*
:
Whether Hostel facility is required * :