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Application Form
 

NOTE:
* denotes required / compulsory to be filled in, before submission. You may also take a printout of this form, fill in the required information and fax/mail it to us. We shall then send you the application form via email in a .pdf format
 

Please fill this form only to apply to an university online. For any other inquiries, please email us at info@medicalstudy.org or use the feedback form
 
Surname *
Name *
Fathers Name
Father's Occupation
Mailing Address *
Telephone (With Code)*
Mobile
Fax
Email *
Citizenship
Date of Birth
Place of Birth

EDUCATIONAL RECORD

SSC

Year of Passing
Marks Obtained

HSSC (10+2)

Year of Passing
Marks Obtained

MBBS/BDS (for P.G. Students)

Year of Passing
Marks Obtained

COURSE PREFERENCES

Course Interested in
MBBS/Graduation in
Name of Preferred Institution *
Medium of Instruction * English
Please provide us with the copy of your passport if available.
(Only the pages with personal photograph and address page are required)

 
 
 
After You recieve the application form sent by us, in order to confirm admission, candidates should fill up the application form and deposit $550 (Rs. 25000/-) in the ICICI Account No. 624205009665, Nagpur-Branch , India. The application form should be mailed to us.
   
 
 
 
 
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