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Registration

This document is a student registration form for the Paramedical Council of India. It requests basic personal information such as name, address, contact details, education history, and details of the allied healthcare course for which registration is being applied. The form must be filled out carefully and submitted along with required documents to register for a diploma or degree in a paramedical course with the Paramedical Council of India.

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Riyas d
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429 views1 page

Registration

This document is a student registration form for the Paramedical Council of India. It requests basic personal information such as name, address, contact details, education history, and details of the allied healthcare course for which registration is being applied. The form must be filled out carefully and submitted along with required documents to register for a diploma or degree in a paramedical course with the Paramedical Council of India.

Uploaded by

Riyas d
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PARAMEDICAL COUNCIL OF INDIA

Student Registration Form


Note : - Fill out the form carefully for Registration.

To Date : - …../…../…….
The Secretary
Para Medical Council of India
Passport Size
Application for Registration of Diploma/degree in (Course) : ……………..……….…………………………… Photo

1. Name of the applicant : ………………………………………………….……………………………………………………..


2. Parent’s Name : …………………………………….…………………………………………………………………………….
3. Date & Place of Birth : ……………………………………….………………………………………………………………….
4. Gender : Male Female Others
5. Are you citizen of India : By Birth By domicile
6. Permanent Address …………………………………...……………………………………………………………………………………………………
District ……………………………………. State ……………………………….. PIN code………………………………….
7. Correspondence Address ……………………………………………………………...............................................................................................
District ……………………………………. State ……………………………….. PIN code…………………………………
8. Mobile/Phone …………………………………………………. E-mail ID ...………………………........................................................................
9. Details of educational qualifications prior to/other than allied and healthcare qualifications:
Educational Name of School/College Board/ University Year of Passing
Qualification
Matriculation or
Equivalent
Senior Secondary or
Equivalent
:::

10. Details of Allied and Healthcare qualification for which registration is applied :
Name of Name of Duration of Name & address Date of Date of
Course Institute/College the Course of Admission Passing Year
(with hospital/Institute
Internship) of Internship

Signature of Candidate

FOR OFFICE USE ONLY


1. Registration Fee …………………………………………….…………………………………………………………
2. Receipt No. ………………………….……………………… Date …………………..……………………………….
3. Registration No …………………………………………………….…………………………………………………...

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