Welcome to I.T.S Dental College & Research Centre
 

Registration

 
Date of Registration………………….
Registration Form for admission to BDS Course

1. Name of Student …………………………………………. 2. Date of Birth ……………………

3. Father’s / Guardian’s Name ……………………………………………………………………..

Address………………………………………………………………………………………………

4. Occupation ………………Designation………………….. 5. Income…………………./Month

6. Telephone No with STD Code (Off) ………………………….. (Res) ………………………….

Mobile No. Self……………………………Father/Guardian……………………………………

7. Marks in qualifying (10+2) Exam: U.P. Board / CBSE / ICSE / Others …………………………

 

10+2 Year of Passing …………

                         10th
S.No.
        Subject
   Mark
 obtained
    Max
 Marks
      Subject
   Mark
 obtained
    Max
 Marks
1.
 
 
 
 
 
 
2.
 
 
 
 
 
 
3.
 
 
 
 
 
 
4.
 
 
 
 
 
 
5.
 
 
 
 
 
 
6.
 
 
 
 
 
 
 
Total =
 
 
Total =
 
 

8. Aggregate % age in qualifying exam: ………………9. Medium of Education : Hindi / English

10. Category / Caste: UPGC / UPBC / UPSC / UPST / OTHER STATE

11. If appeared in UPCAT Entrance: R.No. ………………...Rank ………………………………….

12. Whether College Bus Facilities are required: Yes / No. If Yes , from ………………………

13. Whether Hostel Facilities are required: Yes / No

14. Local Guardian’s Name & Add. ………………………………………………………………….

…………………………………………………………………………………………………………

15. Contact No. – (Off) …………………… (Res) …………………… (Cell) ……………………....



Signature of Father / Guardian Signature of Student

For Office Use
Form No. …………. Date of Admission ………………..
 

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