Dr. D.Y. Patil Vidyapeeth, Pune (DEEMED UNIVERSITY) Application for International Admissions Category : NRI Form No: Please tick the appropriate box UG COURSES MBBS BDS B Sc (Nursing) PB BSc (Nursing) BPT (Physiotherapy) B Tech (Biotechnology) B Optom (Clinical Optometry) ATTACH A RECENT 4.5 cms x 3.5 cms FULL-FACE, COLOUR PHOTOGRAPH HERE PIO FN PG COURSES MBA M Sc (Biotechnology) M Sc (Nursing) M Tech (Biotechnology) MPT (Physiotherapy) General Information Name Last Middle Date of Birth First Gender Day Month Male Female Year Place of Birth City State Country Country of Citizenship Permanent Address PIN Telephone Number of Parent (with area code) Home Office Email (in block letters) Parent Applicationfor forDr. Dr.D. D.Y. PuneAdmissions Admissions2014 2012 Application Y. Patil Patil Vidyapeeth, Vidyapeeth, Pune Student Page 1 Academic Information BIOLOGY Level Level & Final Grade Equivalent % of Marks CHEMISTRY Level & Final Grade Equivalent % of Marks PHYSICS Level & Final Grade ENGLISH Equivalent % of Marks Level & Final Grade Equivalent % of Marks 10th Grade 11th Grade 12th Grade Attached Document Checklist SrNo Document Certified copies of the mark sheet / grade / transcript of the qualifying 1. examination 2. Copy of Passport 3. Proof of NRI status 4. Passport size photographs (5) 5. 6. Processing fee of US $ 200 in the name of The Registrar, Dr. D.Y. Patil Vidyapeeth, Pune payable at Pune. Equivalency certificate issued by AIU, New Delhi (or copy of correspondent letter to AIU for issuance of equivalent certificate) if required 7. Medical fitness certificate 8. Undertaking duly undersigned by the parent / guardian 9. Copy of Visa For admission to PG Course: 1. All the documents mentioned above 2. Degree Certificate 3. Registration Certificate of the concerned National/State Council 4. Migration Certificate/ Transfer Certificate Signature of the Applicant Date nd th Last date of submission of Application Form: 2June July30, 2012 2014 Application for Dr. Dr. D. D.Y. Pune Admissions Admissions2014 2012 2013 Application for Y.Patil PatilVidyapeeth, Vidyapeeth, Pune Page 2 Declaration/ Undertaking 1. I hereby declare that the information given in this form is true and complete to the best of my knowledge. I am aware that, if any information given herein is found to be incorrect or incomplete, my application will be rejected / admission will be cancelled. 2. The admission being granted is of NRI / PIO / FN category. Fees payable by me will be as indicated in the information brochure in US dollars. 3. I further understand that my admission is purely provisional subject to the verification of the eligibility conditions. Signature of the Applicant Date 1. I, Parent/ Guardian of the above applicant, hereby declare that, I am aware of the financial obligations of admitting my child/ ward to the selected Course under Dr. D. Y. Patil Vidyapeeth, Pune. 2. I agree to pay the tuition fee and other fees payable to the College/ Institution and the University, as fixed from time to time, as per the rules. 3. I also affirm and endorse the declaration made above by my child/ ward. Signature of parent/ guardian Date FOR OFFICE USE 1. Validity of Application form checked 2. Sufficient documents attached 3. Eligibility for the Course checked 4. Processing Fee Received 5. Rank in the Inter-se-Merit list 6. Form Checked By (Name & Signature) Yes Yes Yes Yes No No No No Dr. D.Y. Patil Vidyapeeth, Pune Sant Tukaram Nagar, Pimpri, Pune – 411 018 (MS) India Application Applicatio0n forfor Dr.Dr. D.Y. D. Y. Patil Vidyapeeth, Vidyapeeth, Pune Pune Admissions Admission2014 2012 2013 Application for Dr. D. Y.Patil Patil Vidyapeeth, Pune Admissions Page 3
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