Registration
Date of Registration………………….
Registration Form for admission to BDS Course
1. Name of Student …………………………………………. 2. Date of Birth ……………………
3. Father’s / Guardian’s Name ……………………………………………………………………..
Address………………………………………………………………………………………………
4. Occupation ………………Designation………………….. 5. Income…………………./Month
6. Telephone No with STD Code (Off) ………………………….. (Res) ………………………….
Mobile No. Self……………………………Father/Guardian……………………………………
7. Marks in qualifying (10+2) Exam: U.P. Board / CBSE / ICSE / Others …………………………
10+2 Year of Passing ………… | 10th | |||||
S.No. | Subject | Mark obtained | Max Marks | Subject | Mark obtained | Max Marks |
1. | ||||||
2. | ||||||
3. | ||||||
4. | ||||||
5. | ||||||
6. | ||||||
Total = | Total = |
8. Aggregate % age in qualifying exam: ………………9. Medium of Education : Hindi / English
10. Category / Caste: UPGC / UPBC / UPSC / UPST / OTHER STATE
11. If appeared in UPCAT Entrance: R.No. ………………...Rank ………………………………….
12. Whether College Bus Facilities are required: Yes / No. If Yes , from ………………………
13. Whether Hostel Facilities are required: Yes / No
14. Local Guardian’s Name & Add. ………………………………………………………………….
…………………………………………………………………………………………………………
15. Contact No. – (Off) …………………… (Res) …………………… (Cell) ……………………....
Signature of Father / Guardian Signature of Student
For Office Use
Form No. …………. Date of Admission ………………..
10. Category / Caste: UPGC / UPBC / UPSC / UPST / OTHER STATE
11. If appeared in UPCAT Entrance: R.No. ………………...Rank ………………………………….
12. Whether College Bus Facilities are required: Yes / No. If Yes , from ………………………
13. Whether Hostel Facilities are required: Yes / No
14. Local Guardian’s Name & Add. ………………………………………………………………….
…………………………………………………………………………………………………………
15. Contact No. – (Off) …………………… (Res) …………………… (Cell) ……………………....
Signature of Father / Guardian Signature of Student
For Office Use
Form No. …………. Date of Admission ………………..
