Registration Details

Select Programme(s) you are applying to

*Select Programme(s) you are applying to

Post Graduate Diploma in Emergency Medical Services (PGDEMS)

Post Graduate Diploma in Healthcare Simulation and Interprofessional Education and Practice (PGDHSIEP)

Personal Information

*Applicant Name (as per 10th /12th Mark Sheet /certificate)

*Gender

Male

Female

*Date of birth

*Nationality

*Category

*Mobile number

*Primary Email

*Retype Primary Email

Work Experience details

*Do you have work experience?

Yes

Education Information - X std

*School / College

*Year of Passing

*Board

Note: No special characters are allowed

Board If others, please specify

*Tenth Percentage (%)

Education Information - XII std

*School / College

*Year of Passing

*Board

Note: No special characters are allowed

Board If others, please specify

*Twelfth Percentage (%)

Degree Details

*Passed / Appeared

Education Information - UG

*Your UG qualifying degree

*Your UG Specialization

*Institute / College

*Year of Passing

If university studied is outside India, choose 'University outside India'

*Your UG University name

Note: No special characters are allowed

University name if Others, please specify

Present Address

*Address line 1

Address line 2

Address line 3

*City

*State

*Pin code

*Is permanent address same as above?

Yes

Upload your current passport size photo (not more than 3 months old)

The upload photo should be in .jpg or .jpeg or .gif or .png formats only and the photo size should be between 10 KB and 150 KB.

*Upload photo

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