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Harsha Application 2022

This document is an application form for admission to a university. It requests information such as the student and parents' names, contact details, nationality, caste, gender, entrance exam details, qualifying exam details, address, guardian information, course applying for, documents required for admission, a declaration agreeing to university policies, and whether the student requires hostel accommodation. Fees are also outlined for each year of study. Spaces are provided for admission approval and recording admission details.

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Arghadeep Das
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© © All Rights Reserved
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59 views

Harsha Application 2022

This document is an application form for admission to a university. It requests information such as the student and parents' names, contact details, nationality, caste, gender, entrance exam details, qualifying exam details, address, guardian information, course applying for, documents required for admission, a declaration agreeing to university policies, and whether the student requires hostel accommodation. Fees are also outlined for each year of study. Spaces are provided for admission approval and recording admission details.

Uploaded by

Arghadeep Das
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Affix your

BANGALORE Passport size


Photograph here
APPLICATION FORM
Admission No.

Student Information

Student's Name: D.O.B. / /

Father's Name: Mobile

Mother's Name: Mobile

Nationality Caste : Sex : M / F

Nationality Citizenship /Aadhaar No.

Entrance Test Details : Examination Rank No.

Qualified Examination Passed : Registration No. :

Permanent Address: Local Guardian Address:

Relationship with Student :


Student Mobile : Mobile :

Course Applying for :


NURSING M.Sc., Nusing ALLIED HEALTH SCIENCE PHARMACY
GNM Paediatric B.Sc. in Medical Laboratory Technology D. Pharmacy
B.Sc. Medical Surgical B.Sc. in Imaging Technology (MRI/CT Scan Technician) B. Pharmacy
P.B.B.Sc. Community B.Sc. in Opera on Theater & Anesthesia Technology
B.Sc. in Perfusion Technology
OBG PHYSIOTHERAPY
B.Sc. in Optometry BPT
Psychiatry
B.Sc. in Renal Dialysis Technology MPT (Master of Physiotherapy)
B.Sc. in Emergency Medicine Technology - Muscular Skeletal Sciences
B.Sc. Lateral Entry - Sports Sciences
BHA ‐ Bachelor of Hospital Administra on - Cardio - Vascular & Pulmonary Sciences
- Paediatrics
- Neurological Sciences
PARAMEDICAL SCIENCES MANAGEMENT - Movement Sciences
DMLT ‐ Diploma in Medical Laboratory Technology BBA Aviation (Bangalore University)
DXRT ‐ Diploma in X‐Ray Technology B.Com. Logistics PRE‐UNIVERSITY (10+2)
DOTT ‐ Diploma in Operation Theatre & Anesthesia Technology Science ‐ (PCMB, PCMC)
BCA
DDT ‐ Diploma in Dialysis Technology
B.Ed. Integrated
DOT ‐ Diploma in Ophthalmic Technology
Documents Required Affix photocopies (Originals to be Produced at the time of selection interview)
SSLC Marks Sheet / 'O' Level Cumulative Record along with syllabus pertaining to qualifying examination
II PUC / 10+2 / PDC Marks Sheet / 'A' Level (for foreign nationals)
Transfer Certificate Degree Certificate & Marks Sheets (For B.Ed., and PG Programs)
Conduct Certificate (issued from institution last studied) CET Allottment Letter with Fees Paid Receipt (For Govt. Quota)
Migration Certificate from the concerned University/Board Industrial Experience Certificate
Recent 4 Passport & 1 Stamp size latest Colour Photographs Income & Caste Certificate (if applicable)
Student Passport Visa (for foreign nationals) Diploma Certificate / Marks Sheets / Registration for Pc.B.Sc.
Citizenship proof (Aadhar, Passport, Nagarikta) (for lateral entry students)

Declaration
I / we pledge that all information provided herewith is true to the best of our knowledge. I /we fully agree to abide by all the
policies, rules and regulations of the institution and in case of non-confirmation would accept the verdict of the institution as
the final. I/we also understood and accept that in case of discontinuation of the course for any reasons. I/we shall forgo the
entire fee including deposits paid to the institution and not claim any reimbursements for compensations.

Hostel : Yes No Sharing : 4 3 2 Attach Non Attach Hostel Fees : ___________

Signature of Parent / Guardian Signature of Student Signature of Thumb Impression

Date :
Place :

For Office Use only


Description 1st Year 2nd Year 3rd Year 4th Year

................................................ ................................................ ................................................ ................................................ ................................................


................................................ ................................................ ................................................ ................................................ ................................................
................................................ ................................................ ................................................ ................................................ ................................................
Total Fees
................................................ ................................................ ................................................ ................................................ ................................................

Course ................................................................... Branch ....................................................................

Admitted by Approved by

Code : ...................................................................
Name : .................................................................. Name : ...............................................................................
Mobile : .................................................................

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