Dipanjali pharmacy college, Bhagwatipur, Shringverpur, Prayagraj, Uttar Pradesh, India

Admission Form

Student Name*

Father Name*

Date Of Birth*

Adhar Number*

Address*

State*

Pin Code*

Email*

Contact Number*

Examination	Passing Year	Board/ University	Obtained Marks	Total Marks	Marks (%)
High School
Intermediate/ Diploma

Student Photo*

Domicile*

TC*

CC*

10th Marksheet*

12th Marksheet*

Declaration

I hereby declare that the information given by me is correct. If any wrong information is found in the given information, then my entry should be canceled. Also, if my registration is complete, it will not mean that I have been entered or will be.