Course	DIPLOMA IN ENDOSCOPIC TECHNOLOGY
Name of the Applicant
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Applicants E-mail ID
Sex	Male Female
Date of Birth
Age
Aadhar no
Religion/Caste	Select Hindu Muslim Christian
Category	Select SC ST OEC GENERAL OBC OTHER
Nationality	Indian Other
Address

Details of Parent/Guardian

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Name
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Parents / Guardian contact No:

Details of Qualifying Examination

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Name of Examination
Board/University
Register No. & Year of passing :
Name of Institution:
State

Marks obtained by qualifying examination

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Subject	Marks	Percentage (%)
Physics
Chemistry
Biology
English
PCB (Physics+Chemistry+ Biology)
PCBE (Physics+ Chemistry+ Biology+ English)
Total (Plus One + Plus Two)

Photo and Signature

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SSLC Certificate (Max Size: 500KB) (jpg/png/jpeg)
Plus Two Certificate (Max Size: 500KB) (jpg/png/jpeg)

Declaration

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	I hereby declare that I have read the various clauses in the prospectus for the admission to professional diploma courses 2024-25 and the instructions carefully and I agreed to abide by them. *
	I hereby declare that all the statements in this application are true, complete & correct to the best of my knowledge and belief. *