Registration for PGDPHM and DPHM Courses

Course (PGDPHM/ DPHM) :
Full Name *  
Gender : *  
Date of Birth : *
Category :
Father's Name : *
Mother's Name : *
Occupation of Parents : *
Annual Income of Parents (in Rs.) : *
Present Postal Address :*
Permanent Address :*
Email : *
Mobile No. : *
Educational Qualifications : *
Qualification Board/ University Subject/ Specialization Marks/ Grade Division Year of Passing
Intermediate (10+2)
Post Graduation
Any Other
Ranks / Awards / Achievements (if any)
Please Provide your RTGS Payment Details
UTR No. : *
Date of Payment : *
* I hereby declare that all the information furnished above by me are true and correct to the best of my knowledge and belief. I agree to abide by all the rules, codes and conduct as may be framed from time to time by the institute.
Date :
Place : *
Upload Passport Photo (200x160 px)
(Only JPG files < 50 kb):
Upload Qualification Certificates as a single file
(Only PDF Files < 1 Mb):
If not able to submit the application online, alternatively you can download the application here and mail the filled-in application to :,

Any technical difficulties in filling-up online application may be mailed to :