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INSTITUTE OF PHARMACY & RESEARCH Anjangaon Bari Road, Badnera-Amravati
Admission Enquiry Form 2023-24
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* Indicates required question
Email
*
Your answer
1. Title(Mr./Ms./Mrs.)
*
Your answer
2. First Name
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Your answer
3. Father's Name/Husband's Name
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Your answer
4. Surname
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Your answer
5. Mother's Name
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Your answer
6. Gender
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Male
Female
7. Date of Birth
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MM
/
DD
/
YYYY
8. Category
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SC
ST
VJ/DT
NT
OBC
EWS
Minority
General
9. Validity Certificate available(Y/N)
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Yes
No
10. Whether claiming any concession(Y/N) . If yes under what category
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Your answer
11. Address for communication
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Your answer
12. Contact No.(Father/Mother)
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Your answer
13. Student Contact No.(What'sApp)
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Your answer
Record of Academic Career
14. B. Pharm Year of Passing
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Your answer
15. B.Pharm Percentage (Pointer)
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Your answer
16. Whether Qualified GPAT
*
Choose
Yes
No
17. 16. Whether Qualified NIPER
Choose
Yes appeared and Qualified
Yes appeared , Not Qualified
Not appeared
18. Percentile of GPAT
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Your answer
19. Percentile of NIPER if qualified (Write NA if not appeared or qualified)
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Your answer
20. Interested in the course
*
M.Pharm. (Pharmaceutics)
M.Pharm. (Pharmaceutical Chemistry)
M.Pharm. (Quality Assurance)
21. Would you like to join Institute what'sApp group for Admission information
*
Yes
No
22. Link to join WhatsApp group
https://chat.whatsapp.com/IFPhay7ypeUA9oW8GQIsIZ
Your answer
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