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Personal Details

Student Type

NEW ADMISSION EXISTING STUDENT OTHER

Please select your College

DDC-IP (Pharmacy) DDCM (Management) DDC (B.Ed)

Select Course*

-Please Select Course-D.PharmB.PharmM.PharmB.Ed.MBA Your Course

Branch

(*Leave if Not Applicable)

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Admission required in Year*

-Please Select Year-First Year2nd Year (Lateral Entry)

Academic Year*

-Please Select Year-2019-202020-21

Applied for (Competitive Exam)*
(choose NO if not applied for any competitive exam)

-Please Select -UPSEEJEECUPOTHERNO

Other Competitive Exam Name

Competitive Exam Roll No. (if you have applied for competitive exam)

Student Name*

Your Name

Father's Name*

Father's Name

Mother's Name*

Mother Name

Aadhaar No.*

Category*

-Please Select -GeneralOBCSCST

Religion*

-Please Select -HINDUMUSLIMSIKHCHRISTIANOTHER

Gender*

-Please Select -MALEFEMALE

Date of Birth*

Day 12345678910111213141516171819202122232425262728293031

Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Year 19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005

Academic Information

High School (10^th) Information

High School Board/University*

-Please Select -U P BOARDCBSEICSEOTHERS

High School Other Board/University

High School Roll No.*

High School Subjects*

High School Marks Obtained*

High School Maximum Marks*

High School Passing Year*

-Please Select -19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021

Intermediate (12^th) Information

Intermediate Board/University*

-Please Select -U P BOARDCBSEICSEOTHERS

Intermediate Other Board/University

Intermediate Roll No.*

Intermediate Subjects*

Intermediate Marks Obtained*

Intermediate Maximum Marks*

Intermediate Passing Year*

-Please Select -19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021

Diploma / Graduation Information

Course

-Please Select -DIPLOMAB.A.B.COM.B.SC.B.TECH.B.PHARM.B.B.A.B.C.A.B.E.OTHER

Graduation Board/University

-Please Select -CSJM UNIVERSITY,KANPURAKTU,LUCKNOWBOARD OF TECHNICAL EDUCATION,UTTAR PRADESHOTHERS

Graduation Other Board/University

Graduation Roll No.

Graduation Subjects

Graduation Marks Obtained

Graduation Maximum Marks

Graduation Passing Year

-Please Select -19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021

Contact Information

Email (if available)

Mobile*

Residence Address*

City*

State*

Pin Code*

Following documents are required in college office with this Online Registration Form :*

1. High School Marksheet & Certificate
2. Intermediate Marksheet & Certificate
3. Graduation (If Applicable) Marksheet & Certificate
4. Gap Certificate (If Applicable)
5. TC / Migration Certificate
6. Caste,Income,Domicile Certificate(as applicable)
7. Aadhaar card of candidate,parents & 5 photos of student
8. Character Certificate issued from previous institution
9. Affidavit

   I confirm that the I have verified my information entered above & the information is correct & true to the best of my knowledge :*

Payment Mode*

-Please Select-ONLINE (DEBIT CARD / CREDIT CARD / NETBANKING

ENTER AMOUNT TO DEPOSIT*

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Correct Code

Disclaimer :

This application is for filling of required information for registration for admission. Your application will be considered only after submission of all necessary documents & full fees. Confirmation of admission is subject to availability of seats.