Admission Enquiry Form

    STUDENT DETAILS

    Name
    Email
    Mobile

    Aadhar Number

    Date of Birth

    Gender
    MaleFemale

    Category

    District

    State

    Pin
    Residential Address

    PARENTS DETAILS

    Father's Name
    Father's Occupation
    Contact No.(Father)
    Mother's Name
    Mother's Occupation


    QUALIFYING EXAMS

    PCBPCMPCBM

    10th EXAM DETAILS

    Board/University
    Roll Number
    Maximum Marks
    Marks Obtained
    Percentage
    Passing Year

    12th EXAM DETAILS

    Board/University
    Roll Number
    Maximum Marks
    Marks Obtained
    Percentage
    Passing Year

    D. PHARMA(LATER AL ENTRY) EXAM DETAILS

    Board/University
    Roll Number
    Maximum Marks
    Marks Obtained
    Percentage
    Passing Year

    B. PHARMA(AGGREGATE) EXAM DETAILS

    Board/University
    Roll Number
    Maximum Marks
    Marks Obtained
    Percentage
    Passing Year