First Name*

Middle Name

Last Name*

Mobile No/WhatsApp No. *

Email *

Parent Mobile No/WhatsApp No.

Gender
 Male    Female

Category * selectOPENOBCSCSTVJ-aNT-bNT-cNT-dSEBCEWSSBC

Are you belongs to physically challenge
 Yes    No

Are you belongs to defence category
 Yes    No

10th Class Percentage * %

12th Class Percentage * %

Are you opted for PCB group
 Yes    No

PCB Total [out of 300 ]

Are you opted for PCM group
 Yes    No

PCM Total [out of 300 ]

Applied for Common Entrance Examination i.e. MHT-CET/JEE/NEET?
 Yes    No

MHT-CET/JEE/NEET Roll No

MHT-CET PCB Percentile

MHT-CET PCM Percentile

Admission Query if Any?

Address in Full

Taluka

District

Pincode

Interest of admission * select DIPLOMA IN PHARMACY DEGREE IN PHARMACY

Admission Level * select FY [First Year] DSY [Direct Second Year]

Source * select source Directly Institute Visit Website/Social Media Radio/Newspaper Staff Student/Friend Seminar/Exhibition