Application Form - MPT Admission (2024-25) - KMPIP
Admission Form for Application to the Post Graduate Course in Physiotherapy (MPT) at
K M Patel Institute of Physiotherapy - A Constituent Institute of Bhaikaka University, Karamsad, Gujarat

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INSTRUCTIONS TO APPLICANT
1. Students should carefully read the rules for admission before submitting the application form.

2. Every entry in the form must be completed in detail. Incomplete applications are liable to be rejected.

3. No application for admission will be considered unless it is accompanied by attested copies of the certificates mentioned in the prospectus. Visit this link to see the advertisement and prospectus : http://www.bhaikakauniv.edu.in/

4. Students joining our physiotherapy institute will obtain degree from the Bhaikaka University.
APPLICANT'S DETAILS
Name (As Appearing in the Degree Certificate) *
Sex *
Age *
Date of Birth *
MM
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DD
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Place of Birth *
Married ? *
Citizenship *
Father / Husband's Full Name *
Postal Code *
Phone No. *
(With STD Code)
Mobile Number (WhatsApp enabled) *
Email Id *
Address of Communication *
Permanent Address
Leave blank if same as address of communication
Name of the College/University from where you completed BPT: *
Academic Record *
Please give the details of academic records for 1st, 2nd, 3rd & Final BPT as shown here, (Course, Marks Obtained / Out of, Attempt, Month & Year of Passing).
Percentage of Cumulative Marks in 1st, 2nd , 3rd & Final BPT *
Internship completed: *
If Yes, Date of Completion of Internship:
MM
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DD
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If No, Mention tentative date of completion of internship:
MM
/
DD
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YYYY
GSCPT number if registered 
Submit Your Photo & Documents
Please send your Passport Size Photo, All Year Attempt-wise BPT Mark-sheets, School Leaving Certificate / Transfer Certificate, Passport / Birth Certificate (for proof of birth place), Internship Completion Certificate, Provisional Degree Certificate, Identity Proof (Aadhar Card, Voter ID, License) and details of the fee payment to our email id kmpip@charutarhealth.org along with your name and phone number which you have submitted in this form. Total max size for attachments is 25mb. Please note that for further procedure, sending your documents on our above mentioned email id and payment of form fee Rs 3000/- is mandatory.
Disclaimer *
I solemnly declare that I have personally checked and verified all the information filled in this form and that they are correct and that no relevant information of fact is suppressed or omitted. I undertake to abide by the decision / order of the Admission Committee to cancel my admission and / or expel me from the college and or to prosecute me in case any incorrect information or discrepancy is found in this form either at the time of admission or at any time during the course of my study. I hereby agree, if admitted, to conform to various Rules and Regulations of the Physiotherapy Institute in force and that may hereafter made for the governance of the college and I undertake that so long as I am a student of the college I will do nothing either inside or outside the college that will interfere with its orderly governance, discipline and good.
Required
Date of Submitting the Form *
MM
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