APEEJAY SVRAN INSTITUTE FOR BIOSCIENCES & CLINICAL RESEARCH

Sector-32, Plot-26, Gurgaon, Haryana

Telephone: 0124-4365376
Website: www.apeejay.edu/aibcr/home.html email: aibcr@apj.edu

Application Form for admission 2009-2010

PGDAMT/PGDCMD/PGDBLT/PGDBI/PGDCTM

1. Applicant’s name ………………………………………….

Affix your
2. Father’s name ………………………………………….
passport size
photograph
3. Mother’s name ………………………………………….

4. Date of birth …….. …………………………………..

5. Mailing address ………………………………………….

………………………………………….

………………………………………….

Pin code………........... Phone no. ……

e-mail ………………………………….

6. Course to which admission is sought. If you want to be considered for more than one
course give order of choice (1,2,3,4,5 )
Full time course
1. PG Diploma Analytical & Molecular Techniques (PGDAMT)
2. PG D Clinical Research & Molecular Diagnostics (PGDCMD)
3. PG D Biomedical Laboratory Technology (PGDBLT)
4. PG D Bioinformatics (PGDBI)
Part time Course
5. PGD Clinical Trials & Data Management (PGDCTM)

7. Academic qualification:

Examination Year Name of School / Subjects Max Marks %/

Board/ Univ marks obtained Div
Secondary
Hr. Secondary
Graduation
Post Graduation
(Attach copies of certificates)
8. Category :
Kindly tick the appropriate option ;

General
OBC
SC/ST
(In case of reserved category attached documentary proof copy and kindly bring relevant
original certificate at the time of entrance test)

9. Awards and honours :

10. Extra curricular activities:

11. Training experience / Dissertation (state years/months) :

Declaration by the Applicant

I hereby certify that the above information submitted by me is correct and that I have not
provided any false/concealed any information. I understand that my admission may be
cancelled and tuition fees paid by me fortified, incase any of the above information given by
me at the time of admission is subsequently found to be wrong, concealed or false, I hereby
agree to abide by the rules and regulations as may be prescribed by the Institute.

Signature of the Applicant

Date:…………………………..

Place:…………………………..

For official use only

File no.. Date

Sig of Astt Convenor

Deadlines:

Last date of submitting application : 5th August 2009

Entrance Test:
Admissions will be made on the basis of an index derived from the following:
 aggregate % marks of class 10, 10 +2, BSc or equivalent degree
 GD (group discussion on any contemporary topic irrespective of area
 Interview

Application forms may be submitted as email attachments but hard copies must be
mailed to Coordinator AIBCR at the address given above, along with an entrance fee of
Rs 500/- as demand draft in favour of Apeejay Svran Instt of Biosciences & Clinical
Research, Gurgaon

Students must must bring relevant original certificates for verification with a photocopy
each, at the time of Entrance test.