BHADUTALA PARAMEDICAL INSTITUTE

A unit of RANI SHIROMANI HEALTH & EDUCATIONAL TRUST (RSHET)
Associated With: UGC • NCVRT • Skill India • MSME • NSDC • Sikkim Skill University • Maya Devi University • BSS
Vill+P.O- Bhadutala, P.S- Salboni, Dist- Paschim Medinipur, West Bengal- 721129
Phone No: +91 8670352299 | Email: bhadutalaparamedicalinstitute@gmail.com

APPLICATION FORM FOR ADMISSION

Note: Please read the form carefully before filling it. Attach the required documents with results/score of qualification examinations as mentioned in educational qualification.

Form No.

Course / Program Details

Affiliation

Course Name

Personal Details

Name (Mr./Mrs./Ms.)

Father's Name

Mother's Name

Date of Birth

Age (as mentioned in 10th Certificate)

Religion

Blood Group

Gender

Marital Status

Category

Nationality

Permanent Postal Address (in Full)

House / Street / Area / Village

Post Office

Police Station

District

State

Mobile

WhatsApp No.

e-Mail ID

Educational Qualification

Examination / Grades Passed	Name of the School / College & Board / University	Year of Passing	Subject(s) Studied	Marks Obtained	Maximum Marks	% of Marks Scored
10th
12th
Graduation
Post Graduation
Any Other Qualification

Upload Documents

Aadhar Card

Madhyamik Admit

Madhyamik Marksheet

HS Marksheet

Passport Size Photo

Signature