(Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore & Approved by IAP)
Application for Admission to B. P.T. / M.P.T. Course
1. Name of the candidate in full (block letters) to be entered as found in the certificate of the qualifying examination. *
2. Father’s Name
3. Mother’s Name
4. Name of the guardian and relationship (if father is not alive)
5. Permanent address of father or guardian
6. a) Telephone Numbers *
    b) Email Address *
7. Religion and Caste
8. Whether you belong to Scheduled Caste / Scheduled Tribe / Backward Class. State sect if you belong to Any one of these categories.
9. Occupation of Father / Guardian
10. Annual Income of Father / Guardian
11. a] Date of Birth (In Christian era)
      b] Place of Birth (Here enter Place, Taluk & District)
      c] State of domicile
      d] Mother tongue
      e] Languages which you can read, write and speak
12. Are You –  
      a] A citizen of Indian Union? If not mention nationality
      b] Native of Karnataka State? If not, to which state do you         belong?
      c] Have you applied to the Rajiv Gandhi University for Eligibility         Certificate?  Yes No
13. Academic Particulars
Exam Passed Name and Address of the School / College Name of the Board / University No. of attempts for passing Percentage and class in which passed Year of Passing
a.) SSLC / Matric

b.) PUC / (10+2) or Equivalent Examination

c.) Degree Examination

14.Total marks obtained and percentage of marks secured in aggregate of Physics, Chemistry & Biology upto two decimal Points including Practical Marks.

Marks out of
Aggregate Percentage

15.Professional Experience if any
16. Hobbies
17. Games / Sports
18. List any outstanding performance medals / certificates received.

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