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    GIPS Application Form 2021

    Uploaded by

    Mukul.A. Maharaj
    This document is an application form for admission to various pharmacy programs - D. Pharm, B. Pharm, M. Pharm, and PhD - at the Girijananda Chowdhury Institute of Pharmaceutical Science (GIPS) in Guwahati and Tezpur, Assam. The application seeks personal details of the applicant such as name, date of birth, contact information, educational qualifications, category and other eligibility details. It also contains fields for payment details and preference of branch for M.Pharm applicants.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    GIPS Application Form 2021

    Uploaded by

    Mukul.A. Maharaj
    37 views2 pages
    This document is an application form for admission to various pharmacy programs - D. Pharm, B. Pharm, M. Pharm, and PhD - at the Girijananda Chowdhury Institute of Pharmaceutical Science (GIPS) in Guwahati and Tezpur, Assam. The application seeks personal details of the applicant such as name, date of birth, contact information, educational qualifications, category and other eligibility details. It also contains fields for payment details and preference of branch for M.Pharm applicants.

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    GIPS Application form 2021

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    This document is an application form for admission to various pharmacy programs - D. Pharm, B. Pharm, M. Pharm, and PhD - at the Girijananda Chowdhury Institute of Pharmaceutical Science (GIPS) in Guwahati and Tezpur, Assam. The application seeks personal details of the applicant such as name, date of birth, contact information, educational qualifications, category and other eligibility details. It also contains fields for payment details and preference of branch for M.Pharm applicants.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views2 pages

    GIPS Application Form 2021

    Uploaded by

    Mukul.A. Maharaj
    This document is an application form for admission to various pharmacy programs - D. Pharm, B. Pharm, M. Pharm, and PhD - at the Girijananda Chowdhury Institute of Pharmaceutical Science (GIPS) in Guwahati and Tezpur, Assam. The application seeks personal details of the applicant such as name, date of birth, contact information, educational qualifications, category and other eligibility details. It also contains fields for payment details and preference of branch for M.Pharm applicants.

    Copyright:

    © All Rights Reserved
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    To be filled up and submitted for counselling and Admission Sl. No.

    …………

    GIRIJANANDA CHOWDHURY INSTITUTE OF PHARMACEUTICAL SCIENCE (GIPS)


    (A unit of Shrimanta Shankar Academy)
    Azara, Hatkhowapara, N.H.-37, Guwahati- 781017

    GIRIJANANDA CHOWDHURY INSTITUTE OF PHARMACEUTICAL SCIENCE-TEZPUR


    (An Institute established under PPP model by Shrimanta Shankar Academy and Govt. of Assam)
    Dekargaon, Tezpur, Sonitpur-784501
    APPLICATION FORM
    (SESSION-2021-2022)
    Admission sought in: D. Pharm/B. Pharm/B. Pharm (Practice)/M. Pharm/PhD.

    Admission Opted for: GIPS-Guwahati/GIPS-Tezpur self-sponsored/ GIPS-Tezpur Govt. quota

    1. Name of the applicant :


    in full (in block letters)
    2. Sex (M/F) :

    3. Date of Birth :

    4. Father’s Name :

    5. Mother’s Name :

    6. Father’s Occupation :

    7. Mother’s Occupation :

    8. Family Income :

    9. Postal Address :

    10. Permanent Address :

    11. Parent/Guardian’s Contact Details:

    STD Code: Phone No:

    Mobile No:

    E-mail ID:
    12. Student's Contact Details:

    Mobile No:

    E-mail ID:

    13. Nationality :

    14. Religion :

    15. Caste/ Category: Gen/SC/ST/OBC/MOBC/Others:

    16. Details of Examination Passed :


    Name of Name of Board/ Year of Reg. No. Total Total % of
    the Exam University Passing & Marks Marks Marks
    Roll No. Prescribed Obtained Obtained
    HSLC

    HS.
    (10+2)
    D. Pharm

    B. Pharm*

    M. Pharm#

    GPAT*
    *
    Applicable for only M. Pharm Candidates
    #
    Applicable for only PhD Candidates
    17. Details of marks obtained in H.S./10+2 or Equivalent (Sc.) (only for D. Pharm & B. Pharm)
    Exam Marks secured in % of marks in aggregate of

    Phys. Chem. Math. Bio. PCM PCB


    HS/ 10+2 or
    Equivalent (Sc.)

    18. Proficiency in Co-curricular activities:


    19. Preference of Branch (mention 1, 2, 3 in the box) (For M. Pharm Candidates Only)
    Pharmaceutics Pharmaceutical Chemistry Pharmacology
    20. Payment Details: Cash/Online:
    Transaction No:
    Date of Transaction:

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