Registration Form

Course Applied For*

ANM

GNM

D.Pharm

Student's Name*

Father's Name*

Mother's Name*

Father's Occupation*

Parent's Contact*

Student's contact*

Email*

Category*

General

SC

ST

OBC

Date of birth (mm/dd/yyyy)*

Permanent Address*

Highest Qualification*

HS(10+2)

Graduate

Post Graduate

% Percentage of Marks*

Name of Board or University*

Year of Passing*

Declaration*

I hereby declare that all the above information's are true and any false information is liable to me.

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Anti Ragging Committee

Address

Amgurikhat, P.O. Melamati, P.S. Titabar, District: Jorhat, Assam- 785632 India

Contact

Admission Form