📍 Prakash Nagar, Ward No. 12, Narkatiyaganj, Bettiah, West Champaran, Bihar – 845455

KAUTILYA INSTITUTE & PARAMEDICAL COLLEGE

Prakash Nagar, Narkatiyaganj, West Champaran, Bihar-845455

U And R Institute Of Health & Education Pvt. Ltd.

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1. PERSONAL DETAILS

[Please fill the form using black ball point pen only & in capital letter]

DOCUMENT UPLOADS

Format: JPG, PNG | Size: Max 2MB | Dimensions: 3.5cm x 4.5cm

Format: PDF, JPG, PNG | Size: Max 5MB | Both sides required

Format: PDF, JPG, PNG | Size: Max 5MB | All pages in single file

2. ACADEMIC QUALIFICATION

Provide Complete information on examination obtained in all columns. Marks stated in these columns must tally with those in the original mark sheets. Enclose photocopy of certificates. (Attested by gazetted officer)

Examination Passed Name of the School/College Name of the Board/University Marks Obtained total marks Percentage (Aggregate) Month & Year of Passing
Std. 10th
Std. 12th
Graduate
Post Graduate
Others
3. FAMILY DETAILS
Name Service/Self Employed Name of Organization Place
4. DECLARATION BY STUDENT

- I hereby tender that I will regularly attend the classes and will maintain atleast 80% attendance in my class.

- The eligibility documents submitted by me are true and genuine to the best of my knowledge and belief.

- During the course of study I will not be in any kind of regular job either in any Govt., semi Govt. or Pvt. Authority/Co.

- During the course of study I will not do any other regular course from any other University.

- I will not indulge in any sort of legal cases, whether criminal/Civil during the course of study.

- I understand that the fees once paid will not be refunded.

- I will not involve in malpractice, misconduct, fraud in any manner during any tenure of study in the University.

I confirm that the information given on this form is true, complete and accurate and none of the information requested of other material information has been omitted. I accept if it is discovered that I have supplied false, inaccurate of misleading information, William Carey University reserves the right to cancel my application, withdraw its offer of a place or terminate attendance at the William Carey University and I shall have no claim against William Carey University in relation there to.

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