COLLEGE OF HEALTH SCIENCES
PONDICHERRY INSTITUTE OF MEDICAL SCIENCES
(a Unit of The Madras Medical Mission)
Ganapathichettikulam, Kalapet, Puducherry - 605 014.

Enquiry form for the Health Sciences Courses : Academic Year 2024-25.

admin
Application No : PIMS-CHS98

Health Sciences Programs (Please mention your course as per your perfernce ( 1 , 2 & 3)*

1. B.Sc. Medical Laboratory Technology (MLT):

2. B.Sc.Medical Radiology & Imaging Technology (MRIT):

3. Bachelor of Physitherapy (B.P.T):

I. Personal Details


Name of the Candidate (as given in the degree certificates / SSLC) *

Date of Birth*

Age*

Gender*

MaleFemale

Religion*

Caste Name*

Caste Group (As per caste certificate)
(General/SC/ST/OBC/MBC/BC etc)*

Blood Group*

Aadhar Number*

Name of Father*

Occupation of Father

Name of Mother*

Occupation of Mother

Nationality*

Address for Communication*

Candidate Mobile Number (Compulsary)*

Email ID (Compulsary)*

Parent's Mobile Number *

A. General education

Slno Qualification(S.S.L.C marks Compulsary) Year of passing University/ Board % of marks / grade / class

B. Marks in H.Sc. / Pre University / Any equivalent


Slno Subjects Max. Marks Marks Obtained % of marks

Note:

The students those who are awaitng for the Board Examination results, kindly update the marks in the same application form after the declaration of the result

Self Declaration:

The above details furnished are true to my knowledge and I am responsible for any discrepancy if found and thier consequences.

Date

23/11/2024

Place*

Passport Size Photo*
size should be height--> 200px and width --> 200px allowed formats (PNG, JPEG, JPG)

Signature*
size should be height--> 150px and width --> 250px allowed formats (PNG, JPEG, JPG)