Application Form

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SRI HOMBEGOWDA EDUCATION TRUST(Regd.)

Dr. H.L.T. COLLEGE OF PHARMACY

Kengal, Channapatana, Bangalore(Rural)-571502, Karnataka
Phone: 080-7252572


(Approved by P.C.I., A.I.C.T.E., New Delhi & Affiliated to R.G.U.H.S., Bangalore.)

 

APPLICATION FORM FOR ADMISSION TO PHARMACY

(Enclose DD for Rs. 100 in favour of the Principal Dr. H.L.T. College of Pharmacy. Payable at Bangalore)

 
SELECT THE COURSE
1) NAME OF THE CANDIDATE
(In  block letters as per 10th marks card)
2) A) NAME OF THE FATHER

    B) OCCUPATION

    C) ANNUAL INCOME
3) AGE & DATE OF BIRTH
 
4) A) NATIONALITY
    B) RELIGION
   C) CASTE
(State whether belongs to any  reserved category, if so submit proof
)
5) PERMANENT ADDRESS OF
THE CANDIDATE.
6) PARTICULARS OF QUALIFYING EXAM  
Qualifying
Exam
passed
Name of
the Board
or State
Regd. No. & year of
passing
No of
attempts
Total
marks %
Marks obtained
physics,chemistry,
Maths.
% in
optional
 
7) INSTITUTION AT WHICH THE CANDIDATE STUDIED DURING LAST SEVEN YEARS.
(Give reasions for discontinuation if any in remarks column)
Course year Name of Institution Class
Medium Remarks
   
8) EXTRA CURRICULAR ACTIVITIES
9) NAME & ADDRESS OF A RESPONSIBLE PERSON
    FOR REFERENCE
         
DECLARATION BY THE CANDIDATE
 
I       of    
 
 
hereby declare that the information furnished above is true to the best of my knowledge. I promise to abide the rules & regulations farmed by the college Authorities and also declare that I am liable for any disciplinary action taken by the college authorities incase of any on my default.
Date:
 
DECLARATION BY PARENT
 

I

admitted my

 
 Into

 
Hereby by declare that I will abide the rules & regulations framed by the college authorities.
The College Fee. Examination Fee. Hoste Fee, Etc. Will be paid Withi in the given date. In case of default of my ward. The management and Principal of the college can take disciplinary action.