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Suryadatta Education Foundation's
SURYADATTA INSTITUTE OF HEALTH SCIENCE (SIHS)
ISO 9001: 2015 Certified Institutes & Accredited by NVT - QC, ANAB & IAF
Admission Form 2022
Admission Form 2022
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Bachelor of Physiotherapy (B.P.Th)
I am submitting my application as under:
A) GENERAL INFORMATION
(IN BLOCK LETTERS) (Name of the applicant should be As per HSC Marks Statement / In case of name change, attach the required document.)
Alternate Contact No.:
Adhar Card No.:
Passport No. :
(Ensure your contact no. is correctly recorded as Suryadatta sends many important messages via SMS. Any change in Address / Contact No. / Email must be communicated to Suryadatta immediately.)
Date Of Birth
(as on 1st July 2020)
-- Gender --
Father / Guardian’s Name
Professional Background of Father/Guardian
Mobile No (Father/Guardian)
(including STD Code)
Professional Background of Mother
Email Id (Father/Mother/Guardian)
Alternate Email Id (Father/Mother/Guardian)
Family’s Yearly Income
Sources of Income
Do you have any Brother(s), Sister (s). If so, their name & present occupation
B) POSTAL ADDRESS
C) DETAILS TO BE FILLED BY FOREIGN STUDENTS
Any Relative in Pune / India : Name
University Exam Given
D) ACADEMIC DETAILS (DEGREE / DIPLOMA)
It is mandatory to mention your academic details, without which, your form will not be processed.
10th Board Exam
12th Board Exam
Diploma, if any :
Graduation Specify :
Any Other :
Other Examinations (Please specify)
DETAILS OF NEET
NEET Roll No.
Marks Obtained in Neet Subject
E) Industry Work Experience If Any
F) EXTRA-CURRICULAR ACTIVITIES
This is not a compulsory part. Only those claims which can be substantiated with legitimate certificates need to be mentioned here. Attach separate sheet if required. List not more than three significant achievements in extra-curricular activities.
Hobbies & Interest
Mention your Strengths and Areas of Improvement
Why do you think SURYADATTA is the best option for you?:
G) Other Details
Gen / Open
VJ.NT / VJ.DT
If from reserved category, attach Non Creamy Layer, Cast Validity Certificate from competent Govt. authorities.
b) Are you attaching your Domicile & Nationality Certificate
c) Are you a physically handicapped candidate : If yes, attach disability certificate from competent authorities.
d) Are you an outstanding performer in Academics (Medalist or Rank Holder) in the University / Board. If yes, attach supporting document signed by competent authorities
e) For Master Degree courses : Have you passed your Bachelor’s Degree from a recognized University?
f) Did you have any gap in your continued education. If yes, attach your gap certificate stating reasons for the same.
Your source of information about our Course : (Please tick wherever applicable)
a) MH-CET CELL
e) Current Students
f) Parental Reference
g) Any Other Source
Hostel Facility :
Boarding & Mess
Preferred mode of Payment for fees
Documents to be submitted - Copies only
1. Mark sheets of all examinations
2. Transfer Certificate & Migration Certificate
3. Valid Proof of Address (Submit Photo Copy of any one of the following document)
Original Degree / Diploma Certificates need not be attached at this stage. Original Certificates are required at the time of admission. Those students who are in the final year of Degree course should meet the eligibility criteria on the completion of the course. Those not meeting the eligibility criteria of the Institute will attract cancellation of admission.
Students can collect their original documents after clearing all dues & getting a ‘No Dues’ certificate from the Institute authorities.
H. RULES & REGULATIONS
Read Rules & Regulations
I Confirm that above information is correct and have read the rules and regulations carefully and will follow the same.