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  • Online Application Form - 2021: Undergraduate Degree Courses (Group A)

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    joshan jayapaul pandiyan
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    This document contains an application form for Jenifer Pandiyan to the Christian Medical College in Vellore, India for their summer admission courses. It includes her personal details like name, date of birth, address, family details, and educational qualifications. She is applying as a minority network candidate through the Methodist Church of India. Her preferred courses are MBBS, BSC in Operation Theatre and Anaesthesia Technology, Respiratory Therapy, Optometry, Cardiac Technology, Nuclear Medicine Technology, and Bachelor of Audiology and Speech Language Pathology. She paid her application fees of Rs. 4300 by HDFC bank.

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    This document contains an application form for Jenifer Pandiyan to the Christian Medical College in Vellore, India for their summer admission courses. It includes her personal details like name, date of birth, address, family details, and educational qualifications. She is applying as a minority network candidate through the Methodist Church of India. Her preferred courses are MBBS, BSC in Operation Theatre and Anaesthesia Technology, Respiratory Therapy, Optometry, Cardiac Technology, Nuclear Medicine Technology, and Bachelor of Audiology and Speech Language Pathology. She paid her application fees of Rs. 4300 by HDFC bank.

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    16 views1 page

    Online Application Form - 2021: Undergraduate Degree Courses (Group A)

    Uploaded by

    joshan jayapaul pandiyan
    This document contains an application form for Jenifer Pandiyan to the Christian Medical College in Vellore, India for their summer admission courses. It includes her personal details like name, date of birth, address, family details, and educational qualifications. She is applying as a minority network candidate through the Methodist Church of India. Her preferred courses are MBBS, BSC in Operation Theatre and Anaesthesia Technology, Respiratory Therapy, Optometry, Cardiac Technology, Nuclear Medicine Technology, and Bachelor of Audiology and Speech Language Pathology. She paid her application fees of Rs. 4300 by HDFC bank.

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    of 1

    Christian Medical College, Vellore - 632002. APPLICATION No.

    Online Application form - 2021


    Summer Admission Courses
    1. Name of the Candidate : JENIFER.P 2111949
    2. Father's Name : PANDIYAN.J
    3. Father's Occupation : SEMI-SKILLED WORK
    4. Mother's Name : SARITHA.P
    5. Mother's Occupation : HOUSE WIFE
    Address for communication
    6. House No./Street Name : 3/68 ,SCHOOL STREET, KAMARAJAPURAM
    7. Post office/ Taluk name : KOTHAMANGALAM , K.V KUPPAM
    8. City Name : VELLORE
    9. State name : TAMIL NADU
    Only Candidate's Signature Acceptable
    10. Pin Code : 632104
    11. Mobile No. : 9025312684,9003592760
    12. E Mail Address : jeniferpandiyan3@gmail.com
    13. Date of Birth : 17/03/2003
    14. Gender : Female
    I declare that all information in this form is correct. I understand that
    15. Religion : Christian falsification of data will result in automatic disqualification. I
    hereby declare that I have read the rules & regulations regarding ragging
    16. Community : Backward Class as given in the Prospectus 2021-2022 and agree to abide by the same.
    17. Nationality : Indian Declaration by candidate
    I JENIFER.P child / ward of PANDIYAN.J hereby consent to
    18. State of Domicile : Tamil Nadu the collection, storage and processing of data submitted
    herewith, by Christian Medical College Vellore and
    19. Marital status : Single its authorised agencies for admission, educational and
    related quality purposes.
    20. Mother Tongue : Tamil
    21. Qualifying Examination Completed : Plus Two (+2) T Nadu Board
    22. Course(s) applied for in order of your preference
    : - Basic Administrative Fee Rs. 800
    Undergraduate Degree Courses (Group A)
    Pref Course Code - Course Name Category Code Applying under Minority Network Category (Y/N) Reg Fee
    First 001-MBBS Minority Network (Y) 42-METHODIST CHURCH IN INDIA Rs. 500
    Second 017-BSC OPERATION THEATRE & ANAESTHESIA Minority Network (Y) 42-METHODIST CHURCH IN INDIA Rs. 500
    TECHNOLOGY
    Third 021-BSC RESPIRATORY THERAPY Minority Network (Y) 42-METHODIST CHURCH IN INDIA Rs. 500
    Fourth 006-B. OPTOM. Minority Network (Y) 42-METHODIST CHURCH IN INDIA Rs. 500
    Fifth 020-BSC CARDIAC TECHNOLOGY Minority Network (Y) 42-METHODIST CHURCH IN INDIA Rs. 500
    Sixth 011-BSC NUCLEAR MEDICINE TECHNOLOGY Minority Network (Y) 42-METHODIST CHURCH IN INDIA Rs. 500
    Seventh 008-BACHELOR OF AUDIOLOGY & SPEECH Minority Network (Y) 42-METHODIST CHURCH IN INDIA Rs. 500
    LANGUAGE PATHOLOGY
    Eighth

    23. Has your brother / sister also applied for above course(s) this year : No
    24. City for Entrance Test : First Choice - Vellore Second Choice - Chennai

    Payment Mode : HDFC Total Application Fee : Rs.4300 (Includes Basic Administrative Fee Rs.800)
    HDFC Ref. No: 20210602O0670223 Bank Transid: 202115384927433 Authentication Id: 143907 Status: Yes Online Amount: Rs..4300

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