Skip to content
Location
Majhauli, Ballia (UP)
Call Us
+91
7905826621
Email
shantihospital4@gmail.com
About Us
Organizational Structure
Admin Staff
Central Hospital Staff
Modern Medical Staff (Part-time)
Non Teaching Staff (Ayd.)
Teaching Staff
Teaching Staff as a Consultant
Affiliation
Facilities
Annual report
Act & Rules
Gallery
Event 2022
Academic
Courses
Departments
List of Students
Collaboration
Academic Planning
Feedback Form
Research
Anti Ragging
Clinical
Campus Hospital
Camp Hospital
Affiliated Hospital
Available Clinical Materials
Info
Career
Vacancy Details For Teaching Staff
Vacancy Details For Non Teaching Staff
Vacancy Details For Hospital Staff
Results
OPD/IPD
Contact Us
Student Services
Admission Application Form
X
Admission Application Form
Home
Admission Application Form
ACADEMIC YEAR
PROGRAM
SECTION
FIRST NAME
MIDDLE NAME
LAST NAME
GENDER
MALE
FEMALE
OTHER
DATE OF BIRTH
BLOOD GROUP
A +
A -
B +
B -
O +
O -
AB +
AB -
RELIGION
HINDU
MUSLIM
SIKH
CHRISTIAN
OTHER
CASTE
EMAIL ADDRESS
WHATSAPP NO
MOBILE NO / PHONE NO
ALTERNET MOBILE NO
CATEGORY
GENERAL
OBC
SC
ST
OTHERS
GROUP
HEIGHT
WEIGHT
FATHER NAME
OCCUPATION
FATHER MOBILE NO
FATHER PHOTO
MOTHER NAME
OCCUPATION
MOTHER MOBILE NO
MOTHER PHOTO
CURRENT ADDRESS
PARMAMENT ADDRESS
AADHAR NUMBER
PAN NUMBER
BANK A/C
BANK NAME
IFSC CODE
HIGH SCHOOL / SSC
BOARD
COLLEGE / INSTITUTE / UNIVERSITY NAME
SUBJECTS
TOTAL MARKS
OBTAIN MARKS
PASSING YEAR
CERTIFICATE NO.
INTERMEDIATE/HSC
BOARD
COLLEGE / INSTITUTE / UNIVERSITY NAME
SUBJECTS
TOTAL MARKS
OBTAIN MARKS
PASSING YEAR
CERTIFICATE NO.
GRADUATION / UG
COLLEGE / INSTITUTE NAME
UNIVERSITY NAME
SUBJECTS
TOTAL MARKS
OBTAIN MARKS
PASSING YEAR
CERTIFICATE NO.
POST GRADUATION / PG
COLLEGE / INSTITUTE NAME
UNIVERSITY NAME
SUBJECTS
TOTAL MARKS
OBTAIN MARKS
PASSING YEAR
CERTIFICATE NO.
OTHER ( COURSE NAME )
COLLEGE / INSTITUTE NAME
UNIVERSITY NAME
SUBJECTS
TOTAL MARKS
OBTAIN MARKS
PASSING YEAR
CERTIFICATE NO.
NEET ROLL NUMBER
OBTAIN MARKS
REGISTRATION NO..
UPLOAD RESULT FILE
UPLOAD COUNCIL LETTER
ANY OTHER DOCUMENT
STUDENT PHOTO
STUDENT SIGNATURE
10TH MARKSHEET
10TH CERTIFICATE
12TH MARKSHEET
12TH CERTIFICATE
AADHAR CARD FRONT
AADHAR CARD BACK
PAN CARD
UPLOAD BANK PASSBOOK PAGE WHICH SHOWS IFSC CODE ACCOUNT NUMBER & ADDRESS
Submit
