Form No.

Form Fees :

for U.G. Rs.

600/-

for P.G. Rs. 1,000/At & Po. : Pipariya, Tal. : Waghodia, Dist. : VADODARA 391 746. (GUJARAT) [INDIA]
Phone : +91-2668-245267, Fax : +91-2668-245292, Website : www.sumandeepuniversity.co.in

Application for Admission to : [ Please tick ( )to the appropriate box ] UNDERGRADUATE COURSES NURSING : B.SC. (N) A.N.M. G.N.M. PHARMACY B. PHARM. ELIGIBILITY 12th Pass with 45% (Sci. Stream) 10th Pass with 40% 12th Pass of Arts / Com. / Sci with 40% ELIGIBILITY POST GRADUATE COURSES NURSING : M.Sc. (N) P. Basic Dip. P.C.B.Sc. (N) PHARMACY M. PHARM PHYSIO M.P.T. DIP. M.P.T. ELIGIBILITY B.Sc. (N) with 1 yr. Exp. GNM / B.Sc. + 1 yr. Exp. GNM and Regd. Nurse ELIGIBILITY B.Pharm with 50% marks ELIGIBILITY B. PHYSIO. CERTIFICATE COURSES MEDICAL AAC-2 AAC-3 AAC-4 OTT-2 MLT-2 DENTAL Dental Mechanics ELIGIBILITY Any Graduate ELIGIBILITY M.B.B.S. B.P.N.A. Certified courses in Nursing 12th Sci. (B Group) ELIGIBILITY 12th Pass (Sci. Stream)

12th Sci. Pass with 45% DIP. TO DEGREE (A-AB-B Category) PHYSIO B.P.T. P.G. DIPLOMA ELIGIBILITY 12th Sci. Pass B. Physio.

MNGT. M.B.A.

MEDICAL TECHNICAL PROGRAMME MEDICAL RIT ELIGIBILITY B.Sc. (Physics) B.Sc. (Microbiology) B.Sc. B.Sc. (Physics)

INSTRUCTIONS : 1. Attach sefl attested photo copy of documents wherever necessary 2. Read instructions carefully prior the filling of application form either through prospectus or website. 3. Any dispute regarding admission shall be subject to Vadodara Jurisdiction only. 4. Selected students is required to furnish bank guarantee/ surety bond for the course fee at the time of admission.

MLT-1 ACC-1 OTT-1

Paste latest Passport Size Photograph

1.

(a) Name of Candidate (As per Mark Statement) Surname : First Name : Middle Name : (b) Permanent Address :

Pin code : (c) Address for Communication : if different from (b)

Pin code : (d) Phone No with STD Code : Mobile : (e) E-mail : 2. (a) Father's/Husband's/Guardian/s Name M Gender F

(b) Occupation : (c) Mother/s Name (d) Occupation : 3. (a) Date of Birth : (b) Marital Status Day Single : Month Married : P.T.O. [ 2 ] Year

4.

(a) Nationality : (b) Religion : (c) Community : (d) Category : SC ST OBC SEBC General Others :

5. For FOREIGN STUDENTS : Details of Pass Port & VISA Name of Country Expiry Date & Year : Type of VISA 6. ACADEMIC RECORD Course Year of Passing Institute University / Board Specialization From (dd/mm/yy) To (dd/mm/yy) %age / Grade Rank Day Student Month Tourist Other Year AIDS clearance Certificate Attached : YES NO Passport No. VISA Place of Issue

7.

Sr. No.

Language

Speaking Excellent Good Fiar Excellent

Reading Good Fiar Excellent

Writing Good Fiar

8. CHECK LIST : (As applicable to the Student)

a. Mark Sheet of Qualifying Examination b. Provisional / Degree Certificate c. School Leaving Certificate

d. Caste Certificate e. Migration Certificate f. Score Card of Valid Entrance Test

9. Do you need Hostel Accommodation :

YES

NO

DECLARATION
I declare that the information furnished by me herein is true and correct. In case any information furnished above found incorrect, at any stage, I agree to forgot my claim for admission. The original documents will be produced at the time of funal admission and enrolment. I have read and understand the instruction for filling-up the application form and hereby undertake to abide by all the rules and regulations of the University. Action may be taken against me as per the rules and regulations if I am found to be guilty of misconduct or misbehaviour or any of the form of offence during the course on my study. I know the rules and regulation*. Place : Date : *please observe the website from time to time. For OFFICE USE ONLY ADMITTED WAIT LISTED REJECTED Signature of the Candidate Signature of the Parent

Date of Submission :