Application For Admission

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Application For Admission

Application For Admission

Course :

Name of the Candidate :

Father’s / Guardian’s Name :

Date of Birth:

Place of Birth :

Permanent Address of the Candidate : :

Correspondence address of the Candidate :

Phone No.:

WhatsApp No. :

Email ID.:

Nationality :

Religion:

Caste :

Occupation of Father / Guardian :

Annual Income of Father / Guardian : :

Education qualification :

Name of Qualifying Examinations	Examining Board	Year of Passing	Total Marks	Marks Obtained	% of marks
Metric or Equivalent
Intermediate or 10+2 Equivalent

Subject in Intermediate or 10+2 Equivalent	Maximum Marks	Minimum Marks	Marks Obtained	% of Marks
Physics
Chemistry
Biology
English

Have you suffered from any serious illness in the past :

If so, what were you suffering from :

Have you undergone any surgery:

If yes, what is the nature of surgery :

Candidate’s Photo:

Candidate’s Signature:

Declaration By The Candidate

I wish to apply for admission to Shyamlal Chandrashekhar Medical College, Khagaria and declare that I have filled this form myself and to best of my knowledge and belief, the above particulars are true.

I have gone through the instructions for admission carefully and undertake to abide by all the conditions. I further agree, if admitted, confined to the rules and regulations at present in force or that may hereafter be made for the administration of the College and hostel. I undertake that as long as I am a student of the College and hostel. I will do nothing unworthy as a student of the College either inside or outside or anything that will interfere with its orderly working and discipline. I am aware that the management has the full authority to expel me for disinterest in studies, misbehavior and continuous failures.

Declaration By The Parent / Guardian

I hereby declare that I have known the financial obligation and I can afford to pay all the costs and undertake to pay the tuition and other fees payable to the institutions under the rules framed by the Management to the College.

The Statements made and information furnished in this application by my daughter are to the best of my knowledge and belief.

Signature of the Parent / Guardian:

1. Photocopy of S.L.C / T.C :

2. Photocopy of Secondary Exam Mark Sheet : :

3. Photocopy of Secondary Board Certificate ::

4. Photocopy of Higher Secondary Mark Sheet ::

5. Photocopy of Higher Secondary Board Certificate ::

6. Photocopy of Aadhar Card ::

7. Photocopy of Caste Certificate ::

8. Photocopy of Residential Certificate ::

9. Photocopy of Migration Certificate :

NOTE: Originals of the above shall be delivered at the time of admission without which the Provisional admission is not complete.

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