Application For The Academic Year 2024-25 Step 1 of 5 20% BGS AND SJB GROUP OF INSTITUTIONSBGS HEALTH AND EDUCATION CITY Note: Please read the instructions carefully before filling the form. Incomplete application will be rejected COURSE OPTEDMEDICALNURSINGENGINEERINGALLIED HEALTH SCIENCESMANAGEMENTFASHION DESIGNINGBSc INTERIOR DESIGNINGARCHITECTUREB EdBHMB.DesPHARMACYSELECT STREAMB PHARMPHARM DSPECIALISATIONMEDICAL PGMEDICAL UGSPECIALISATIONNURSING PGNURSING UGNURSING DIPLOMAPB BSc NURSINGSPECIALISATIONENGINEERING PGENGINEERING UGSPECIALISATIONMANAGEMENT PGMANAGEMENT UGSPECIALISATIONBSc FASHION DESIGNINGFASHION DESIGNING LATERAL ENTRYSPECIALISATIONARCHITECTURE PGARCHITECTURE UGSELECT STREAMM ARCHSELECT STREAMB ARCHSELECT STREAMMSc NURSINGSELECT STREAMBSc NURSINGSELECT COLLEGESJB College Of NursingBGS Global Institute Of Nursing ScienceSELECT STREAMMBBSSELECT STREAMMD (DOCTOR OF MEDICINE)MS (DOCTOR OF SURGERY)SELECT SUB STREAMMD GENERAL MEDICINEMD PEDIATRICSMD RADIO DIAGNOSISMD ANAESTHESIOLOGYMD DERMATOLOGYMD BIOCHEMISTRYMD PHYSIOLOGYMD MICROBIOLOGYMD PHARMACOLOGYMD PATHOLOGYMD COMMUNITY MEDICINEMD PSYCHIATRYSELECT SUB STREAMMS GENERAL SURGERYMS ORTHOPAEDICSMS OPHTHALMOLOGYMS ENTMS ANATOMYMS OBGSELECT STREAMBBABCAB COMSELECT STREAMMBAM COMSPECIALISATION*UNDER GRADUATELATERAL ENTRYSELECT STREAM*BSc CARDIAC CARE TECHNOLOGYBSc PERFUSION TECHNOLOGYBSc RENAL DIALYSIS TECHNOLOGYBSc NEUROSCIENCEBSc RESPIRATORY CARE TECHNOLOGYBSc ANESTHESIA & OPERATION THEATER TECHNOLOGYBSc IMAGING TECHNOLOGYBSc MEDICAL LABORATORY TECHNOLOGYSELECT STREAM*CARDIAC CARE TECHNOLOGYPERFUSION TECHNOLOGYRENAL DIALYSIS TECHNOLOGYNEUROSCIENCERESPIRATORY CARE TECHNOLOGYANESTHESIA & OPERATION THEATER TECHNOLOGYIMAGING TECHNOLOGYMEDICAL LABORATORY TECHNOLOGYCHOOSE COURSE PREFERENCE*FIRST PREFERENCESPECIALISATION*UNDER GRADUATELATERAL ENTRYSELECT STREAM*BSc CARDIAC CARE TECHNOLOGYBSc PERFUSION TECHNOLOGYBSc RENAL DIALYSIS TECHNOLOGYBSc NEUROSCIENCEBSc RESPIRATORY CARE TECHNOLOGYBSc ANESTHESIA & OPERATION THEATER TECHNOLOGYBSc IMAGING TECHNOLOGYBSc MEDICAL LABORATORY TECHNOLOGYSELECT STREAM*CARDIAC CARE TECHNOLOGYPERFUSION TECHNOLOGYRENAL DIALYSIS TECHNOLOGYNEUROSCIENCERESPIRATORY CARE TECHNOLOGYANESTHESIA & OPERATION THEATER TECHNOLOGYIMAGING TECHNOLOGYMEDICAL LABORATORY TECHNOLOGYCHOOSE COURSE PREFERENCE*SECOND PREFERENCESELECT STREAMVLSI & ESDIGITAL C & NCSECEDIGITAL ELECTRONICSMACHINE DESIGNCADSSECNESELECT STREAMELECTRONICS & COMMUNICATION ENGINEERINGCOMPUTER SCIENCE & ENGINEERINGINFORMATION SCIENCE & ENGINEERINGELECTRICAL & ELECTRONICS ENGINEERINGCIVIL ENGINEERINGMECHANICAL ENGINEERINGTITLE*MrMissAPPLICANT NAME (IN BLOCK LETTERS ) AS ENTERED IN SSLC /10th STND*GENDER*MALEFEMALEOTHERSAPPLICANT WHATSAPP NUMBER*APPLICANT EMAIL* DATE OF BIRTH*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PLACE OF BIRTH*AADHAR CARD NUMBER*NATIONALITY*RELIGION*CASTE / SUB CASTE*MOTHER TANGUE*BLOOD GROUP*CONTACT NUMBER*FATHER NAME*OCCUPATION & ANNUAL INCOME*CONTACT NUMBER*Email MOTHER NAME*OCCUPATION & ANNUAL INCOME*CONTACT NUMBER*Email PERMENENT ADDRESS* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country POSTAL ADDRESS IS SAME AS PERMENT ADDRESSYESNOPOSTAL ADDRESS Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country BGS AND SJB GROUP OF INSTITUTIONSBGS HEALTH AND EDUCATION CITY Note: Please read the instructions carefully before filling the form. An incomplete application will be rejected DETAILS OF S.S.L.CNAME OF BOARD*MONTH & YEAR*SELECT 112345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SUBJECTS STUDIED*MARKS AWARDED (MARKS/MAX)*PERCENTAGE*CONSENT* THE DETAILS CORRECT TO MY KNOWLEDGEDETAILS OF 2nd PUC / EQUIVALENTNAME OF BOARD*MONTH & YEAR*SELECT 112345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SUBJECTS STUDIED*MARKS AWARDED (MARKS/MAX)*PERCENTAGE*CONSENT* THE DETAILS CORRECT TO MY KNOWLEDGEDETAILS OF DEGREE / DIPLOMA (OPTIONAL)NAME OF BOARDMONTH & YEARSELECT 112345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SUBJECTS STUDIEDMARKS AWARDED (MARKS/MAX)PERCENTAGECONSENT THE DETAILS CORRECT TO MY KNOWLEDGEPROFICIENCY IN CO-CURRICULAR ACTIVITIES (OPTIONAL )TO BE SUPPORTED BY CERTIFICATESLIST ALL CO CURRICULAR ACTIVITIESCONSENT THE DEATILS ARE CORRECT TO MY KNOWLEDGE BGS AND SJB GROUP OF INSTITUTIONSBGS HEALTH AND EDUCATION CITY Note: Please read the instructions carefully before filling the form. Incomplete application will be rejected Students may skip this step by clicking "Next" button. UPLOAD DOCUMENTSAPPLICANT PHOTO*Accepted file types: jpg, png, pdf. * SIZE SHOULD BE LESS THAN 10MB APPLICANT SIGNATURE*Accepted file types: jpg, png, pdf. * SIZE SHOULD BE LESS THAN 10MB PARENT SIGNATURE (OPTIONAL)Accepted file types: jpg, png, pdf.* SIZE SHOULD BE LESS THAN 10MB SSLC CERTIFICATE (OPTIONAL)Accepted file types: jpg, png, pdf.* SIZE SHOULD BE LESS THAN 10MB2nd PUC / EQUIVALENT CERTIFICATE (OPTIONAL)Accepted file types: jpg, png, pdf.* SIZE SHOULD BE LESS THAN 10MBDEGREE / DIPLOMA CERTIFICATE (OPTIONAL)Accepted file types: jpg, png, pdf.* SIZE SHOULD BE LESS THAN 10MBAADHAR CARD (OPTIONAL)Accepted file types: jpg, png, pdf.* SIZE SHOULD BE LESS THAN 10MBTRANSFER CERTIFICATE ( TC ) (OPTIONAL)Accepted file types: jpg, png, pdf.* SIZE SHOULD BE LESS THAN 10MBMIGRATION CERTIFICATE (OPTIONAL)Accepted file types: jpg, png, pdf.* SIZE SHOULD BE LESS THAN 10MBSTUDY / CONDUCT CERTIFICATE (OPTIONAL)* SIZE SHOULD BE LESS THAN 10MBCO CURRICULAR CERTIFICATES (OPTIONAL) Drop files here or Accepted file types: jpg, png, pdf. * SIZE SHOULD BE LESS THAN 10MB BGS AND SJB GROUP OF INSTITUTIONSBGS HEALTH AND EDUCATION CITY Note: Please read the instructions carefully before filling the form. Incomplete application will be rejected DECLARATION BY THE CANDIDATECONSENT* I AGREE TO THE DECLARATION• I hereby declare that the information provided in this application is true and complete to the best of my knowledge and belief, without evasion or misrepresentation. In case any information given in this application proves to be false or incorrect, I shall be responsible for the consequences. • I agree to abide by all the Rules and Regulations of the Institute in force and those which may be framed from time to time by the management. • I undertake that I will do nothing unworthy of a student of the Institute either inside or outside the campus or anything that may interfere with its orderly working and discipline. I am aware that the management has the full authority to expel me for disinterest in studies, misbehavior and repeated failures in tests/exams or absenteeism. • I agree that I will not indulge in Ragging and am aware that Ragging is banned in this Institute. If at any point of time, any incident of ragging comes to the notice of the authority, and if I cannot give satisfactory explanation, the authority may expel me from the Institute. PLACE*Date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 BGS AND SJB GROUP OF INSTITUTIONSBGS HEALTH AND EDUCATION CITY Note: Please read the instructions carefully before filling the form. Incomplete application will be rejected DECLARATION BY THE PARENTCONSENT* I AGREE TO THE DECLARATIONI hereby declare that I am aware of the financial obligations of admitting my son/daughter/ward to BGS Allied Health Sciences. I agree to pay the tuition and other fees payable to the Institute, as prescribed from time to time. I also affirm and endorse the declaration made by my son/daughter/ward. PLACE*Date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920