भारतीय चिकित्सा परिषद उत्तराखंड
अजबपुर कलां, मोथरोवाला रोड़, देहरादून-248001
ADMISSION APPLICATION FORM-2024
** Note: Please read the addmission notice carefully before filling online addmission form
Adhar No. Of Candidate :
*
**12 digits
Course Name for Training :
Ayurvedic Bhaisjya Kalpak(Pharmacist)
Ayurvedic Paricharika(Nursing)
Panchkarma Sahayak(Technician)
Unani Bhaisjya Kalpak(Pharmacist)
Yog Evam Prakritik Chikitsa Sahayak
Bank Draft No.
Date
Bank Name & Address
Amount
*
*
*
500
300
Candidate Name:
*
Father's Name :
*
Mother's Name:
*
Date of Birth (according to 10th certificate) :
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
01
02
03
04
05
06
07
08
09
10
11
12
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
(DD/MM/YYYY)
Reservation Category:
GEN
OBC
SC
ST
*
Reservation Sub-Category, if any :
NONE
FF
MP
PH
WOM
*
Permanent Address (As according Domicile):
*
Pin Code:
*
** 6 digits
Correspondence Address:
*
Pin Code:
*
** 6 digits
Mob. No.
*
**10 digits
Educational Qualification :
Exam Name
Board Name
Passing Year
Max. Marks
Obt. Marks
Percentage
High School
*
(For Nursing and Panchkarma Sahayak , wirte down only marks of Physics, Chemistry and Biology and max. marks will be 300)
Exam Name
Board Name
Passing Year
Hindi or Other
English or other
Physics or other
Chemistry or other
Biology or other
Max. Marks
Total marks
Percentage
Intermediate
*
Upload Document:-
**12 digits
Upload Passport Size Photo :
*
Upload Signature :
*