KHYBER MEDICAL UNIVERSITY APPLICATION FORM FOR ADMISSION UNDERGRADUATE PROGRAMS SESSION FALL 2017 Serial No. _________ (The form should be filled in BLOCK letters) read the instructions given in the admission policy in the prospectus and on the reverse Note: Please of application form before filling this form. Applicant shall pay Rs. 2500/- in KMU A/C No. 1450-8, NBP Hayatabad township branch, Near NADRA office, Phase-V, Hayatabad, Peshawar and attach the original fee receipt at the time of submission of application form. 1. Please tick (√) only one program applying for. 2. Submit separate application forms for applying against more than one program OR discipline. DOCTOR OF PHYSICAL THERAPY (05 YEARS) BS OCCUPATIONAL THERAPY (04 YEARS) BS IN LANGUAGE AND SPEECH THERAPY (04 YEARS) BS NURSING (04 YEARS) BS PARAMEDICS (04 Years) BS PARAMEDICS in following Disciplines:- [Please tick, In-Service Candidates Only] Anesthesia Cardiology Dental Disciplines in BS PARAMEDICS Pathology (MLT) Radiology Surgical Program: Dialysis Emergency Care Intensive Care 3. Please tick (√) only one against which applying for? Open Merit (KP / FATA / PATA) FATA-IN Baluchistan Name: Father/Husband Name: (As per SSC or equivalent certificate in BLOCK letters) Date of Birth (dd/mm/yyyy): Gender: Male / Female Domicile: CNIC No.: Nationality: Mailing Address: Contact No. (Tel: Res) Cell: Email: Permanent address: In case of emergency please contact: Name& Parentage: Address: Cell/Tel: Application Processing Fee: Amount: Rs. Receipt No. Dated: EDUCATIONAL RECORD: Annual Qualification Year of Exam. Total Obtained Name of / Supply / Marks Attempts (SSC & onward) passing Roll No Marks Marks Board / University Improved If Have you appeared in ETEA Entrance test-2017 for Medical/Dental colleges: ( Yes / No), yes, please provide the following information:- Year ETEA ID Marks Obtained 2017 Page 01 of 02
KHYBER MEDICAL UNIVERSITY APPLICATION FORM FOR ADMISSION UNDERGRADUATE PROGRAMS SESSION FALL 2017 Serial No. _________ (The form should be filled in BLOCK letters) Note: Please read the instructions given in the admission policy in the prospectus and on the reverse of application form before filling this form. Applicant shall pay Rs. 2500/- in KMU A/C No. 1450-8, NBP Hayatabad township branch, Near NADRA office, Phase-V, Hayatabad, Peshawar and attach the original fee receipt at the time of submission of application form. 1. Please tick (√) only one program applying for. 2. Submit separate application forms for applying against more than one program OR discipline. DOCTOR OF PHYSICAL THERAPY (05 YEARS) BS OCCUPATIONAL THERAPY (04 YEARS) BS IN LANGUAGE AND SPEECH THERAPY (04 YEARS) BS NURSING (04 YEARS) BS PARAMEDICS (04 Years) in following Disciplines:- BS PARAMEDICS [Please tick, In-Service Candidates Only] Disciplines in BS PARAMEDICS Program: Anesthesia Cardiology Dental Pathology (MLT) Radiology Surgical Dialysis Emergency Care Intensive Care 3. Please tick (√) only one against which applying for? Open Merit (KP / FATA / PATA) FATA-IN Baluchistan Name: Father/Husband Name: (As per SSC or equivalent certificate in BLOCK letters) Date of Birth (dd/mm/yyyy): Gender: Male / Female Domicile: CNIC No.: Nationality: Mailing Address: Contact No. (Tel: Res) Cell: Email: Permanent address: In case of emergency please contact: Name& Parentage: Address: Cell/Tel: Application Processing Fee: Amount: Rs. Receipt No. Dated: EDUCATIONAL RECORD: Qualification (SSC & onward) Year of passing Annual / Supply / Marks Improved Exam. Roll No Total Marks Obtained Marks Attempts Name of Board / University Have you appeared in ETEA Entrance test-2017 for Medical/Dental colleges: ( Yes / No), If yes, please provide the following information:- Year ETEA ID Marks Obtained 2017 Page 01 of 02
Admission%20Form%20Undergraduate%20Programs.Fall%2017_1.docx