Online Application Form
Name in (BLOCK LETTERS)
Address for Communication
Tel No:
Mob:
Permanent Address
Tel No:
Mob:
Date of Birth
Age
Gender
Nationality
Religion
Caste
Place of Birth
Details of Parents/Guardian
| Father | Mother | Guardian | |
|---|---|---|---|
| Name | |||
| Occupation | |||
| Address (Use Pin code) | |||
| Tel. No. | |||
| Mob.No | |||
| Income |
Qualifications (+2)
| Name of the Qualifying Examination | |||||||
| Name of University / Board | |||||||
| Register No | Year of Passing | ||||||
| Subject | Physics | Chemistry | Biology | Maths | Bio-Tech | Comp.Science | Total |
| Marks obtained | |||||||
| % of Marks obtained | |||||||
| Medium of Instruction | |||||||
Details of NEET Examination
| Roll No / Application No | |||||
| Marks Obtained | |||||
| Physics (Out of 180) | Chemistry (Out of 180) | Biology (Botany & Zoology (Out of 360)) | |||
| Total (Out of 720) | Percentile Score | NEET All India Rank | |||
Details of KEAM
| 2018 Roll No / Application No | 2018 Qualifying Mark | Are you KEAM Eligible |
Other Information
| Name and address of the School / College Last attended | |
| Whether the candidate was a member of Sports / NCC / NSS / Arts others (Enclose copy of certificates) |
Enclosure: attested copies of:-
Certificate and Mark list of the Qualifying Examination, Entrance Rank Certificate, GRADE 10 Certificate in
proof of age, Caste and Community Certificate, Course and conduct certificate from the institution last
attended, Transfer Certificate (in case not enclosed should be produced at the time of Admission) Any other
relevant certificate in proof of any claim made in the Application.
Upload Photo*
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Upload Certificate of the Qualifying Examination
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Upload Mark list of the Qualifying Examination
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GRADE 10 Certificate in proof of age
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Caste and Community Certificate
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Course and conduct certificate from the institution
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Transfer Certificate
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Sports / NCC / NSS / Arts others (Upload copy of certificates if any)
Accepted File Types: jpg, pdf,png. Accepted size:Below 1Mb.
Declaration by the Applicant
I, hereby declare that the information furnished by me are true to the best of my knowledge and belief. If any information is proven to be wrong, I hereby agree to abide by any action taken by the college including expulsion from the college.Declaration by the Parent/Guardian
I, Hereby solemnly affirm and declare that I am fully aware of the declaration made by the applicant, my son/daughter/ward and take full responsibility for the statements made by him/her. The other statements and the information given are true, correct and complete to the best of my knowledge.© 2023 Shree Vidyadhiraja Homoeopathic Medical College. Developed by Teknika solutions