EX-STUDENT’S DETAILS-PROFORMA
*Name:
*Year of MBBS Admission :
Select Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Post MBBS Qualifications :
Subject :
Superspeciality Qualification :
College from which PG completed:
*Are you working as Teacher of any Medical College? :
Select
Yes
No
If yes, Name of the Medical College :
Place of your working :
Designation :
Noteworthy
Achievements :
*Address for Correspondence :
*City :
*State :
Name of the Spouse :
Qualification :
Occupation :
Phone Nos. :
Mobile No. :
Residential :
Office/Clinic :
Email Address :
One page write-up along with photograph for inclusion in "DYPU, who is who" Booklet to be published.
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