AIIMS Patna Student Management System

Student Registration Form

Student Information

Course Name*

Department*

SESSION*

SESSION MONTH*

MARITAL STATUS*

Whether Physical Handicapped*

Admission Date*

Rank*

First Name*

Middle Name

Last Name*

Date of Birth*

Blood Group*

Category*

Gender*

Nationality*

Religion*

Email Address*

Identification Mark*

Father Name*

Mother Name*

Contact Details

Correspondence Address

State*

District*

Town/Village*

Police Station*

Pin*

Land Line

Mobile*

Street Address*

Permanent Address Same as above

State*

District*

Town/Village*

Police Station*

Pin*

Land Line*

Mobile*

Street Address*

Emergency/Local Guardian Contact

Guardian First Name*

Guardian Last Name*

Guardian Mobile No*

Relationship Type*

Guardian Address*

Medical Registration Details

Permanent Medical/Dental Registration No*

Name of State Medical Council*

Permanent PG registration No.

Educational Qualification(Under Graduate)

College Name*

State*

City*

University*

Passing Year*

% of Marks*

Division*

Upload Image*