PARAMEDICAL COLLEGE, DURGAPUR

Application Form

Fields marked with * are mandatory.

COURSE: *

AVAILING HOSTEL FACILITIES: *

PERSONAL INFORMATION

CANDIDATE'S NAME *

DATE OF BIRTH *

GENDER *

CATEGORY *

BLOOD GROUP

NATIONALITY *

MARITAL STATUS *

FAMILY INFORMATION

FATHER'S NAME *

FATHER'S OCCUPATION *

FATHER'S CONTACT NO. (+91) *

MOTHER'S NAME *

MOTHER'S OCCUPATION

MOTHER'S CONTACT NO. (+91)

FAMILY INCOME (ANNUAL) *

LOCAL GUARDIAN (IF ANY) (OPTIONAL)

CONTACT NO. (+91) (OPTIONAL)

ADDRESS (OPTIONAL)

CONTACT INFORMATION

CANDIDATE'S CONTACT NO. (+91) *

CANDIDATE'S CONTACT EMAIL *

PERMANENT ADDRESS *

STATE *

PIN *

PRESENT ADDRESS *

STATE *

PIN *

ACADEMIC INFORMATION

QUALIFICATION *

MAJOR SUBJECTS *

BOARD / UNIVERSITY *

PASSING YEAR *

PERCENTAGE *

QUALIFICATION (OPTIONAL)

MAJOR SUBJECTS

BOARD / UNIVERSITY

PASSING YEAR

PERCENTAGE

QUALIFICATION (OPTIONAL)

MAJOR SUBJECTS

BOARD / UNIVERSITY

PASSING YEAR

PERCENTAGE

OTHER INFORMATION

WHAT BROUGHT YOU TO PARAMEDICAL COLLEGE, DURGAPUR?

DOCUMENTS

PHOTO (MAX 100KB) (JPG, PNG) *

SIGNATURE (MAX 100KB) (JPG, PNG) *

10TH MARKSHEET (MAX 2MB) (JPG, PNG, PDF) *

12TH MARKSHEET (MAX 2MB) (JPG, PNG, PDF)

GRADUCATION MARKSHEET (MAX 2MB) (JPG, PNG, PDF)

I hereby declare that the information given by me in the Application is true, complete and correct to the best of my knowledge and belief. *