Full name

Email Address

Phone Number

Date of Birth (DD/MM/YYYY)

Gender
MaleFemaleOther

Nationality

Aadhaar Number (if applicable):

Permanent address (Permanent)

City

State

Postal Code

Country

Correspondence Address (if different from Permanent Address)

City

State

Postal Code

Country

Educational Background High School (10th Grade)
Name Of School

Year of Passing

Percentage/Grade

Higher Secondary (12th Grade):
Name Of School

Year of Passing

Percentage/Grade

Previous College/University (if applicable):
Name of Institution

Year of Passing

Degree/Course

Percentage/Grade

Course Applied For
M.D. in Alternative MedicineB.A.M.S. (Bachelor of Alternative Medicine)BEMS (Bachelor of Electro-Homeopathy Medicine and Surgery)Diploma in PharmacyDMLTDOTTDPTDDTECGG.N.MD.N.Y.S.

Declaration
I hereby declare that the information provided above is true and correct to the best of my knowledge and belief. I understand that providing false information or withholding correct information may result in the rejection of my application or termination of my enrollment at Sharawasti Institute of Health Science.
Check

Applicant's Name

Date

Your message (optional)