Name Of Applicant*

Applicant Image

Category(Gen/SC/ST/OBC/PH)*

If Applicable please upload Category certificate

Father's Name(as per Secondary Certificate)*

Mother's Name(As per Secondary Certificate)*

Gender*

Male

Female

Not To Disclose

Date Of Birth(as given the Secondary School Certificate Issue by Board) (dd/mm/yy)*

Upload Date Of Birth Certificate

Age as on 1st July 2021

Hostel Required(Pl.tick)*

Yes

Marks Obtained in 10+ 2 or equivalent examination (English + best of 4 subjects) in any Stream (Science/Arts/Commerce/Vocational)

Subject

Max. Marks

Marks Obtained

% of Marks

Year Of Passing

Subject

Max. Marks

Marks Obtained

% of Marks

Year Of Passing

Subject

Max. Marks

Marks Obtained

% of Marks

Year Of Passing

Subject

Max. Marks

Marks Obtained

% of Marks

Year Of Passing

Subject

Max. Marks

Marks Obtained

% of Marks

Year Of Passing

Subject

Max. Marks

Marks Obtained

% of Marks

Year Of Passing

Upload 12th Marksheet

Upload Leaving Certificate

Affirmation/Declarartion

That Above Particulars are true and the Orignal of the Same Shall be produced on the date of physical reporting at the institute (as per NCHM Guideline)

(Please upload SIgnature of the Candidate)

Correspondence Address

Date(dd/mm/yy)

Place

Email Id*

Contact No:*

Please Bring original of all the documents for verification with four passport size photographs at the time of reporting

Application Form For Admission in B.Sc(H&HA) Academic Year 2021-22 (For Vacant/Residual Seats)

Thank you