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Suryadatta Education Foundation's
SURYADATTA COLLEGE OF PHARMACY, HEALTHCARE & RESEARCH (SCPHR)
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Admission Form 2023
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Admission Form 2023
Upload Passport Size Photograph (Max file size : 1MB , Allow file type : jpg,jpeg,png,pdf only. )
COURSE
D Pharma
B Pharma
I am submitting my application as under:
A) GENERAL INFORMATION
(IN BLOCK LETTERS) (Name of the applicant should be As per HSC Marks Statement / In case of name change, attach the required document.)
Name:
Contact Email:
Contact No:
Alternate Contact No.:
Adhar Card No.:
PAN No.:
Passport No. :
Valid Till
(Ensure your contact no. is correctly recorded as Suryadatta sends many important messages via SMS. Any change in Address / Contact No. / Email must be communicated to Suryadatta immediately.)
Date Of Birth
Age
(as on 1st July 2022)
Gender:
-- Gender --
Male
Female
Other
Nationality
Religion
Father / Guardian’s Name
Professional Background of Father/Guardian
Designation (Father/Guardian)
Mobile No (Father/Guardian)
Residence No.
(including STD Code)
Mother Name
Professional Background of Mother
Designation (Mother/Guardian)
Email Id (Father/Mother/Guardian)
Alternate Email Id (Father/Mother/Guardian)
Family’s Yearly Income
Sources of Income
Do you have any Brother(s), Sister (s). If so, their name & present occupation
B) POSTAL ADDRESS
Communication Address
Country
State
City
Pincode
Permanent Address
Country
State
City
Pincode
C) DETAILS TO BE FILLED BY FOREIGN STUDENTS
Passport No.
Passport Issued
Valid Till
Visa No.
Visa Type
Valid Till
Nationality
Country
Any Relative in Pune / India : Name
Relationship
Contact No.
Email Id
Address
University Exam Given
D) ACADEMIC DETAILS (DEGREE / DIPLOMA)
It is mandatory to mention your academic details, without which, your form will not be processed.
10th Board Exam
12th Board Exam
Diploma, if any :
Graduation Specify :
Any Other :
Other Examinations (Please specify)
DETAILS OF NEET
NEET Roll No.
Marks Obtained in Neet Subject
Computer Literacy
E) Industry Work Experience If Any
Experience 1:
Experience 2:
F) EXTRA-CURRICULAR ACTIVITIES
This is not a compulsory part. Only those claims which can be substantiated with legitimate certificates need to be mentioned here. Attach separate sheet if required. List not more than three significant achievements in extra-curricular activities.
Activity 1
Activity 2
Language Known
English
Hindi
Other
Hobbies & Interest
Mention your Strengths and Areas of Improvement
Why do you think SURYADATTA is the best option for you?:
Health Records
G) Other Details
a) Category
Gen / Open
SC
ST
OBC
SBC
VJ.NT / VJ.DT
SEBC
Jain Minority
Others
If from reserved category, attach Non Creamy Layer, Cast Validity Certificate from competent Govt. authorities.
Yes
No
b) Are you attaching your Domicile & Nationality Certificate
Yes
No
c) Are you a physically handicapped candidate : If yes, attach disability certificate from competent authorities.
Yes
No
d) Are you an outstanding performer in Academics (Medalist or Rank Holder) in the University / Board. If yes, attach supporting document signed by competent authorities
Yes
No
e) For Master Degree courses : Have you passed your Bachelor’s Degree from a recognized University?
Yes
No
f) Did you have any gap in your continued education. If yes, attach your gap certificate stating reasons for the same.
Yes
No
Your source of information about our Course : (Please tick wherever applicable)
a) MH-CET CELL
Yes
No
b) Magazine
Yes
No
c) Internet
Yes
No
d) Alumni
Yes
No
e) Current Students
Yes
No
f) Parental Reference
Yes
No
g) Any Other Source
Hostel Facility :
Only Boarding
Boarding & Mess
No
Preferred mode of Payment for fees
Own Source
Education Loan
Documents to be submitted - Copies only
1. Mark sheets of all examinations
2. Transfer Certificate & Migration Certificate
3. Valid Proof of Address (Submit Photo Copy of any one of the following document)
Driving Licence
Passport
Voters ID
Aadhar Card
Ration Card
Note :
Original Degree / Diploma Certificates need not be attached at this stage. Original Certificates are required at the time of admission. Those students who are in the final year of Degree course should meet the eligibility criteria on the completion of the course. Those not meeting the eligibility criteria of the Institute will attract cancellation of admission.
Students can collect their original documents after clearing all dues & getting a ‘No Dues’ certificate from the Institute authorities.
H. RULES & REGULATIONS
Read Rules & Regulations
Click here
I) DECLARATION
I Confirm that above information is correct and have read the rules and regulations carefully and will follow the same.
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