Application Form for Courses

Application form for Courses

Given Name

Middle Name

Surname / Family Name

Gender

Email ID

Nationality

Date of Birth

Passport No.

Contact Number

Upload Photo (I-Card Size) (.jpg/.png format and maximum size 5 MB)

Passport (.jpg/.png format and maximum size 5 MB)

Permanent Address of Residence

City

Country

Address for Correspondence

City

Country

Registration / Licence Number

Registration / Licence Authority

Registration Date

Registration Expiry Date

Type of Registration

Type of Program

Course

Educational Qualifications

(upload attested photo copies of certificates and marks sheets in certificates section)

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Degree Obtained	Level of Degree	College / University Name	Year	Grade / Percentage

Certificates

List of certificates(.jpg/.png/.pdf format and maximum size 5 MB)

Certificate Name	Certificate

Important :Fellowships and Clinical Training for Doctors require to obtain Temporary Permission from the National Medical Commission of India.

Fees -

USD 2000 per annum : Tuition
USD 6000 per annum : Stay & Food
Other duration : Pro-rata basis
Minimum duration is one month : Tuition USD 200; Stay & food USD 500

1) I certify that the above information given by me is complete and true. In the event of information being false, my application can be canceled.
2) I certify that I have not been found guilty by any court of any offense of moral decimation nor is there any such case against me in any jurisdiction.

Declaration: I Agree