BHADUTALA PARAMEDICAL INSTITUTE

A unit of RANI SHIROMANI HEALTH & EDUCATIONAL TRUST (RSHET)
Affiliated by : AICTV & Government of West Bengal Based on TR Act, 1882 (Govt. of India)
Authorised by: NSDC (Govt. in India), SSU (UGC Approved University)
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 of/with results/score of qualification examinations as mentioned in educational qualification.

Form No.

Registration No.

Course / Program Details

Course Type

Course Name

Personal Details

Name (Mr./Mrs./Ms.)

Father's Name

Occupation

Mother's Name

Occupation

Date of Birth

Age (as mentioned in 10th Certificate)

Gender

Male

Female

Other

Marital Status

Married

Unmarried

Nationality

Indian

Other

Permanent Postal Address (in Full)

State

District

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

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Madhyamik Marksheet

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