Student Information Form
Course *
Semester / Year *
Surname *
Name of the student(First name) *
Father's Name (Middle Name) *
Mother's Name *
Gender *
Permanent Address *
Pin Code *
Parent's contact no (Landline with STD Code) *
Parent's occupation with address *
Parent's Income ( In Rs / Year) *
Student's contact no (Mobile) *
E.mail Address *
Adhaar Card No of student *
Blood Group *
Religion *
Caste *
Category *
Physically handicap *
Economically backward Class *
Date of Birth (dd/mm/yyyy) *
MM
/
DD
/
YYYY
Place of Birth *
Nationality *
Date of admission (dd/mm/yyyy) *
MM
/
DD
/
YYYY
ACPC merit No *
Local/Hostel Address *
Board Exam *
Year of Board Exam (mm/yyyy) *
Board Exam Seat no *
Marks obtained in Board Exam (Obtain/Total) *
Percentage obtained in Board Exam *
Percentile obtained in Board Exam *
qualifying Exam *
GPAT All India Rank (Only M.Pharm student)
Year of qualifying Exam (mm/yyyy) *
Seat no of qualifying Exam *
Marks obtained qualifying Exam (Obtained/Total) *
Percentile obtained in qualifying Exam *
Recent Passport Size Photograph *
Required
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