Form Fee Rs.

200/-
B.M. INSTITUTE OF MENTAL HEALTH
Nr. Nehru Bridge, Ashram Road, Ahmedabad-380009
Phone : (079) 26578256, 26578257, 26578258,26574858
Email: bminstitute.ahm@gmail.com
Website-www.bminstituteofmentalhealth.com Affix Latest
Passport Size
Photograph
Application Fee Rs: 200/- (Two Hundred Only)

Transaction ID NO (UPI/IMPS/NEFT) : ___________________ Date: _________

APPLICATION FORM
POST GRADUATE DIPLOMA IN REHABILITATION PSYCHOLOGY (PGDRP) YEAR 2024-25
(The application form must be filled by Candidate in English only.)
Name of the Candidate:

Surname:

First Name:

Father’s /Husband Name:

Date of Birth:
D D M M Y Y Y Y
Gender: Marital Status: Single / Married / Other:

Nationality: Category: Gen OBC SC ST PWD EWS

Complete Postal Address (in block letter) Permanent Address of Father / Guardian

(Please do not write your name or father’s name) (Please do not write your name or father’s name)

______________________________________ ____________________________________
______________________________________ ____________________________________
______________________________________ ____________________________________
______________________________________ ____________________________________

PIN ___________________________________ PIN_________________________________

Phone No. : ____________________________ Phone No. : __________________________

Email ID-1: _____________________________ Email ID-2: ___________________________

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Details of qualifications :( Educational /Technical / Professional)

Name of Year Aggregate

Exam Class/ Subject No of
School / of University Percentage
Passed Division Taken Attempt
College passing
Ph.D

M.Phil.

Master

Bachelor

Any Other

*Note: If the degree given to students is based upon CPI / SPI / CGPA, it is compulsory to attach
percentage conversion certificate of concern University, otherwise form will be rejected.

Languages Know:
Language Speak Read Write
English

Hindi

Gujarati

Other

Please state “Why do you want to join the training programme”

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Eligibility Criteria (As per RCI Norms):
Minimum educational requirement for admission in PGDRP course will be,
 Bachelor’s degree (regular mode) with general psychology courses in all the three years.
OR
 Master’s degree in any branch of Psychology either in regular or distance mode.
OR
 Master’s degree in counseling psychology either in regular or distance mode.
with a minimum of 55% marks in aggregate. For SC/ST/OBC category, minimum of 50% marks
in aggregate is essential. Entry qualification shall be from a UGC recognized university.

Below mentioned documents must be attached with the application:

1. Statement of marks of Bachelor Degree (All Semester marksheet separately).
2. Attested copy of 10thPassing certificate and School leaving certificate.
3. Proof of valid OBC / SC/ ST / PWD/EWS (As per Govt. of Gujarat Norms) certificate.
4. Proof of valid PWD (As per Govt. of India Norms) certificate.
5. Certificate of Higher /Professional Qualification, if any, in the field of rehabilitation.
6. Certificate of Academic achievements and experience, if any in the field of rehabilitation.
7. Self-Attested copy of Aadhaar Card.
8. Form Fee Rs. 200/- only through NEFT: Bank detail is as under.

Bank : Axis Bank Ltd.

Account Name : B. M. Institute of Mental Health (Education).

Account No : 003010101221798

IFSC Code : UTIB0000003

Branch : Ahmedabad (GJ)

9. Photocopy of transaction ID must be attached with application form.

Note: Submission of application form with all self attested copy of

necessary documents sent by Courier / Post / In Person shall be
accepted before 15-07-2024 till 5:00PM at BMIMH, Near Nehru Bridge,
Ashram Road, Ahmedabad-380009.

Date: ________________ ______________________

Place: ________________ Signature of Applicant

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 IMPORTANT INSTRUCTION
Application Fee:
The application fee for PGDRP at BMIMH is ₹200/-(Two Hundred only). Candidates can make
the payment of application fee through UPI services.

Important Dates:
Start Date of Applications 02-07-2024

Last Date of Submitting Application 15-07-2024 till 5:00 PM

Important Instructions:

1. Multiple application forms will be not considered by the same candidates at any cost.
2. If an individual wants to apply for more than one program, he /she will have to fill out
two separate applications.
3. Application in another mode other than OFFLINE MODE is not acceptable.
4. All disputes pertaining to admissions shall be subject to the jurisdiction at
Ahmadabad, Gujarat only.
5. The Institute reserves the right to make changes in the schedule of written
examination/ personal interview.
6. Incomplete application form or the form submitted after the last date on account of
any reason shall not be consider for admission.

Candidates are advised to visit regularly our website

https://www.bminstituteofmentalhealth.com/ from time to time in this regards.
For admission related query, please contact – 079 – 26578256/57/58/59
Mobile – 8154968086 or write to bminstitute.ahm@gmail.com.

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