Student ID: ____________

FOR OFFICE USE ONLY

Upload your
recent passport
size photograph
here.

ADMISSION FORM
(Please fill the form in CAPITAL LETTERS only)

COURSE APPLIED FOR

ADD ON COURSE

MODE
eLearning - Full Time eLearning - Weekend Online

Class Room - Full Time Class Room - Weekend

Email ID _______________________________________ Mobile No. __________________________________

(SMS – For Communication)

Mobile No. __________________________________

(WhatsApp – For Communication)

First Name _______________________________________ Last Name __________________________________

(Tick Appropriate) Mr./Ms./Mrs./Prof./Dr.

Date of Birth _____________________________________ Gender M F

(DD/MM/YYYY)
Please Tick √ the relevant box

Residence Address ____________________________________________________________________________

(Permanent Address)

____________________________________________________________________________________________

City ____________________ State __________________ Country _________________ Pin _______________

Phone ______________ _________________________ Mobile ______________________________________

(STD Code) (Number) (SMS – For Communication)

Address for Correspondence ____________________________________________________________________

(Please ignore if same as Residence Address)
____________________________________________________________________________________________

City ____________________ State __________________ Country _________________ Pin _______________

Phone ______________ _________________________ Mobile ______________________________________

(STD Code) (Number)

P.T.O
EDUCATIONAL QUALIFICATION: (Graduate and onwards)

YEAR COURSE UNIVERSITY CITY PERCENTAGE

WORKING EXPERIENCE: (Most Recent)

Name of the Present Company Position Period City Salary

Where did you hear about Cliniminds

Internet Friends Advertisement Industry Referral Cliniminds Promotion Cliniminds Alumini

Date : _____________

Place: _____________

Terms & Conditions:

1. THEPL reserves the rights to offer admission in the courses.

2. Registration Fee is non-refundable.
3. Program once you have selected and have been admitted into, cannot be changed.
I have read and understood the terms & conditions of various policies of the Company as mentioned in the
prospectus, and in this form & promise to abide by the same.

(Signature of the Student)

Reset Form Cliniminds, Unit of Tenet Health Edutech Pvt. Ltd.

NOIDA ONE 602, Tower B Plot B8, Sector 62,NOIDA 201309,UP

Mobile: +91 99100 68241, +91 95601 02589, +91 98100 68241
E-mail: info@cliniminds.com Website: www.cliniminds.com