Amar Jyoti Institute of Physiotherapy
(UNIVERSITY OF DELHI)

Bachelor of Physiotherapy 2021-22

NOTES:
1. Kindly read all instructions prior to filling the form.
2. Application form contents 4 sections. All sections need to be filled completely.
3. Keep payment details ready (Credit Card / debit card).
4. Keep all relevant documents like 10th, Degree, caste certificate etc. ready in PDF format.
5. Recent pass port size photo (soft copy) 1.5MB.
6. Fill in the details and click on Next to proceed.
7. Use Mouse to move between fields for entry of data. Do not use Tab Key.
8. Fields marked *are mandatory.

KIND ATTENTION:

All Application are being advised to check for “Thank you mail” for successful submission after a completion of payu money transaction.
In case you do not receive any such mail, you are requested to kindly contact us at admission@ajipt.org Ph. 22379827 within 24 hrs. along with the transaction details.

Application Form

Personal Information

*First Name

*Last Name (In case of no last name then kindly write NA)

*Date of Birth (DD-MM-YYYY)

*Gender
Male Female Transgender

*Age on 31st Dec. 2021 (YY-MM-DD)

*Nationality

*Category
NRI

*Father's Name

*Mother's Name

Correspondence Details

Current Address

*Line 1

Line 2

Town/City

*State

*Pin Code

*Country

Permenant Address: Is it same as current address?
Yes No

Telephone No (91- 1122379827)

*Mobile No.

*E-mail

*Alternate Mobile No.

Alternate E-mail

Educational Details

Academic Records (Class X onwards)

(Please enclose self attested copies of testimonials only. Originals to be produced at the time of admission)

Examination	Board/University	Marks Obtained	Maximum Marks	Percentage (%)
*10^th Class
12^th Class

Are the result of the qualifying exam declared?
Yes No

Subject-wise Marks in 12th (10+2) Senior Secondary/Qualifying Examination

Subject	Marks Obtained	Max. Marks	Percentage (%)
*Physics
*Chemistry
*Biology
*English

		*Aggregate % PCBE

Declaration

I understand that my application will be considered Complete for further processing for admission 2021-22 only if I submit result of 12th/ equivalent exam.
I hereby declare that particulars stated in this application and enclosures, are true to the best of my knowledge and belief. I have read the General Rules and Regulations and satisfied myself that I fulfill all the eligibility requirements prescribed. In the event of my being found ineligible at any stage, I understand that I will be refused the opportunity and my admission will be cancelled.
If admitted, I promise to abide by the Rules, Regulations, Discipline norms and sexual harassment policy of the Institution / University.
*Signature of Applicant (file should not exceed more than 1.5MB.)
I have fully read the information furnished by my son /daughter and affirm that it is true. I understand that if it is proved that the information is fraudulent, my wards admission will be cancelled with immediate effect and I will be liable for criminal prosecution. I have also read the general rules and regulations and have satisfied myself that my ward satisfies all eligibility requirements. Furthermore I will make all attempts to ensure that my ward abides by all the rules, regulations, discipline and norms and sexual harassment policy of the Institution /University.
*Signature of Father/Mother/ Guardian (file should not exceed more than 1.5MB.)