Prayas Psychiatric Rehabilitation Center In Bhopal

Internship Type

Internship Type :

Internship Period :

Registration Form

Registration Year: Upload Image:

Applicant's General Details

Candidate's Name:

Candidate's DOB:

Father's/Guardian's Name: Mother's/Guardian's Name:

Gender: Category: Nationality:

Identity Type: Identification No.: Medical History (Mental issues, Blood Pressure, Asthma):

Do you have a Domicile of M.P.?

Yes

Are you a PwD Candidate?

Yes

Are you diabetic?

Yes

Contact Details

Address

District Pin Code

Email Address

Alternate Email Address

Contact No.

Alternate Contact No.

Qualification Details

Degree Level	Degree Name	College Name	Course Stream	Final Year Status	Percentage (%)	Year of Passing/Appearing
				In Final Year Result Awaited Completed