Application Form ( Sankalp MBBS)
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Sankalp MBBS
My burning desire to become Doctor.
Name
*
First Name
Middle Name
Last Name
Gender
*
Please Select
Male
Female
Transgender
Date of Birth
*
-
Month
-
Day
Year
Date
Father's Name
*
First Name
Middle Name
Last Name
Mother's Name
*
First Name
Middle Name
Last Name
Father's Education
Please Select
Below 10
10th
Intermediate
Graduation
P.G.
Father's / Mother's profession
*
Farmer
Daily wage worker
Private job
Govt job
Unemployed
Other
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number
*
Please enter a valid phone number.
WhatsApp Number
Please enter a valid phone number.
Name of School Currently studying
Medium of study
*
Please Select
English
Hindi
Aadhar Number
*
Percentage of Marks in 10th
*
Subjects in XI-XII
*
Physics
Biology
Chemistry
Maths
Aadhar card copy pdf upload here or image file download below
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Monthly family income in Rupees
*
Choose the correct option/s about you
*
Studying in local coaching centre / Tuition
Never took tuitions
Can do self study of 10-12 hours daily
Not comfortable in English
Wish to study in Hindi medium only.
Terms and Conditions
*
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