Salokaya Faculty of Health Sciences: Online Application Form

Personal Details

First Name

Last Name

Date of Birth

Place of Birth

Email ID

Mobile No.

Nationality

Category

GEN

OBC

Medium of Instruction in School

Class (X)

Class (XII)

Correspondence Address:

Permanent Address:

Program Applying For:

PERSONAL INFORMATION FORM

Awards

Name of Award

Year Received

Level of Competition

Family Information

Member	Name	Age	Degree	University	Occupation/Organization
Father
Mother

Educational Background

Name of College/University

Year Passed

% Aggregate Marks Obtdained

Subject of the class

Payment through Online Debit Card / Credit Card / Net banking

Note: Candidates are required to submit attested copies of the mark sheet during the admission.
I hereby declare, that the above particulars are true and correct to the best of my knowledge. I have read the prospectus and I fully agree and consent to the terms & conditions enclosed with the application form. I fully understand that in the event of my violation of any of the rules and regulation, I am liable to immediate dismissal from the college and I will not hold the college responsible for the same. Further I consent to undergo the course for its full duration. I undertake that I will not cause disrespect or loss of reputation by indulging in malpractices / immoral/illegal acts which amounts to indiscipline and warrants dismissal from the college.

I have read and do hereby consent to the Terms & Conditions for Admission and Course of Study and mentioned in the prospectus.

Payment Details