Student Registration Form

Registration Form for MDS Course
Admission 2023

Name of Student:

Date of Birth :

Mobile no :

Gender: Male Female

Email :

Nationality :

NRI :

Address :

Father / Guardian name:

Mob :

Address :

Occupation:

Designation :

Mother's Name :

Occupation :

Mobile no :

Telephone no. with STD Code(off) :

(Res) :

State of Domicile :

Name of the Schoollast attended :

Aggregate % in qualifying (10+2) Exam :

Board/ CBSE/ ICSE /Others :

Aggregate % in PCB :

Aggregate % in English :

Medium of Education:

(HINDI/ENGLISH)

Category/ Caste:

If appeared in NEET Entrance :

(Form no/Roll no) :

(Rank) :

Aggregate in BDS :

Internship completion date :

Do you need Bus Facility: Yes/ No :

Do you need Hostel Facility: Yes/ No :

Local Guardian's Name & Address :

Contact No.(off) :

(Res) :

(Mob.) :

Admission Fee structure will be strictly as per DMER/Government of Haryana/Pt. B.D Sharma University of Health & Sciences Rohtak/DCI-2017.