Promotion Form Nims University
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4NIMS UNIVERSITY
Fully empowered & incorporated as a regular & full-fledged University vide
NIMS UNIVERSITY ACT, 2008 duly recognized by Government of India
under the provisions of Section 2f & Section 22 of UGC Act, 1956.
FACULTIES:
Medicine
Dentistry
Engineering
Advanced Engg.
Management
Law
Pharmacy
Nursing
Science &
Technology
Physiotherapy
Allied Health Sciences
Fashion
Media
Mass Comm.
Hospitality
Aviation
Education
Library Sciences
Physical Education
Films & Television etc. & a multi-specialty 700-bedded tertiary level Hospital on campus
DIRECTORATE OF DISTANCE EDUCATION
PROMOTION FORM
ACADEMIC YEAR 2011-12
Paste Recent
Photograph
(Do not Staple
Name of Course: ………………………… Promoted Year/Semester …………..
or Pin)
When to appear ……………. Final Part Exam. Month ………….. Year ……...
When you have passed first professional examination ………………………….
Name and Address of the Guidance and Learning Resource Centre:
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
To be filled in CAPITAL letters only
th
1.
Candidate’s Name (As given in Class 10
Certificate):
2.
Date of Birth:
3. Gender:
M
F
D D M M Y Y Y Y
4.
Marital Status
Single / Married
5. Nationality:
6. Category: GEN
SC
ST
OBC
OTHERS
7.
(a)
Father’s/ Guardian’s/ Husband’s Name:
(b) Mother’s Name:
8.
Father’s/ Guardian’s/ Husband’s Occupation:
9.
Annual Family Income (Rs.)
10. Address for Correspondence:
Pin Code
STD Code
Landline No.
Mobile No.
E-mail ID
11. Fees Details (in Rs.)
Particulars
By Cash
By Demand Draft
(Rs.)
D.D. No.
Name of Bank
Date
Amount
(Rs.)
Application Fee
Tuition Fee
Exam Fee
Total Amount
Rs. in Words:
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