On-Campus Application-Form

Instruction:

• Registration Limit: Registration is restricted to one entry per email address and phone number. We recommend reviewing all information thoroughly before submitting your form.
• Confirmation: Upon successful submission, you will receive a confirmation email. Please ensure you check both your inbox and spam folder.
• Technical Support: If you encounter any issues while completing the online application, please contact the Academic Team at acad@iiphd.org or call +9111 45566956 or +91-7042073761.

Course * Select a Course Master in Public Health - Health Science and Technology - IIT Kharagpur Master of Public Health - AcSIR Integrated MSc (Clinical Research) & PhD Post Graduate Diploma in Public Health Management

First Name *

Last Name *

Father’s / Mother’s / Spouse Name *

Gender *
SelectMaleFemaleOthers

Click here to UPLOAD PHOTO

Date of Birth *

Nationality *

Category *

SC ST OBC General

Do you belong to the PwD category? *

Yes No

Do you belong to the EWS category? *
Yes No

Applicant Status *
Nominated Self-Sponsored

Academic Background (Attach Proof)

You are allowed to upload JPG, JPEG, PNG and PDF files only. Maximum upload file size limit is 250KB.

Class X *

Class XII *

Bachelors/ Undergraduate Degree *

Post graduate/Master’s or any other relevent qualification

Any additional Qualification/Training

List of recent academic awards/achivements (if any)

Work Experience

Total work experience in completed years:

Organization

Designation

From

To

Preferred entrance exam location *

Delhi Kolkata

Enclosures

You are allowed to upload JPG, JPEG, PNG and PDF files only. Maximum upload file size limit is 250KB.

Certificates of any course equivalent to 10+2 Mathematics undertaken at a recognized Open University/open school

Latest Curriculum Vitae / Resume *

Additional files such as internship certificate, experience certificate, council registration etc. to be uploaded as a single file

Statement of Purpose*

(This needs to be a 200-300 word summary stating professional goals and career plans including plans and expectations in pursuing this program)

Applicant’s Address for Communication

Address *

State *

Country *

Pincode *

Phone (Residence)

Mobile *

Email *

How did you come to know about PHFI Academic Programs? * SelectGoogle SearchFriend/Relative/ColleaguePHFI website/IIPH-Delhi websitePamphlets and PostersPublic Health SeminarsFaculty/Counsellors of my instituteAlumni/Students of IIPH-DelhiPHFI/IIPH-Delhi Training Program/WorkshopsSocial media platforms of IIPH-Delhi (i.e. Instagram, Facebook, LinkedIn and 'X' etc.)

I hereby declare that the information given is true and correct.

Submit & Proceed to Payment