VISHNU DENTAL COLLEGE
Bhimavaram-Vishnupur-534202
PERMITTED BY DENTAL COUNCIL OF INDIA, NEW DELHI
(No.DE-6(114)-Misc-III-2019/796)
APPLICATION FORM FOR ADMISSION TO DIPLOMA IN DENTAL MECHANIC COURSE
APPLICATION FORM FOR ADMISSION TO DIPLOMA IN DENTAL MECHANIC COURSE
Name of the Student*
as per SSC
Name of the Parent/Guardian
Academic Year
Academic Year
2019-2020
Date of Birth
Age
Nationality
Religion
Religion
HINDU
CHRISTIAN
MUSLIM
Caste
caste
OC
BC-A
BC-B
BC-C
BC-D
SC
ST
EBC
Address for Communication
Permanent Address for Communication
Student Mobile No
Academic Record
Class
Academic Year
Month & Year of passing
Percentage (%)
Class
SSC
Academic Year
2018-2019
2017-2018
2016-2017
2015-2016
2014-2015
2013-2014
2012-2013
2011-2012
Division
First class
Second class
Third class
INTERMEDIATE
Academic Year
2018-2019
2017-2018
2016-2017
2015-2016
2014-2015
2013-2014
2012-2013
2011-2012
Division
First class
Second class
Third class
Identification Marks
Hostel Facility
Required
Not Required
Food Tradition
Vegetarian
Non Vegetarian
Distance from Residence to College
Height Record
a.) Height
b.) Weight
c.) Vision
d.) Blood Group
Blood Group
O+
O-
A+
A-
B+
B-
AB+
AB-
e.) Details of any serious illness
Family Background
Educational Qualifications
Occupation
Phone No. (including Mobile No.)
Father
Mother
Siblings
Details of the local guardian (if any)
Extra Curricular Activities
a.) Sports
b.) Cultural
c.) Any Other
Student Photo
submit
