R.C. Patel Institute of Pharmaceutical Education and Research, Shirpur.
Near Karwand Naka, Shirpur-425405- Dist- Dhule.

ADMISSION ENQUIRY FORM-2020-21 For First Year B. Pharmacy.

Contact- 02563 155189, 9371455559, 9511790384
Name of Student ( As Per SSC Marksheet) In Capital Letters. *
Gender *
Date of Birth of Student *
MM
/
DD
/
YYYY
Mobile No. (Whatapp No. Preferably) *
E. mail ID of Student
Category of Student
Clear selection
Residential Address *
Parent Mobile No. (Whatsapps No. Preferably ) *
SSC Percent % *
HSC Total Marks *
HSC Percent % *
Physics + Chemistry+ Biology = Total Marks (HSC PCB Total) *
Physics + Chemistry + Maths= Total Marks (HSC PCM Total) *
MH-CET Appeared *
NEET Appeared *
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