Application FormFor

Admission into B.D.S. Course

Batch Session

oStudents who have passed in S.S.C/'0' Level and H.S.C/'A' Level examination from any Board in Bangladesh or equivalent examination from abroad in the pre-medical group with physics, chemistry and biology, are eligible to apply for admission if they have qualifying marks as per Government rules .o Application must be filled-up and submitted along with the under -mentioned documents - Attested photocopy of the certificate of S.S.C/'O' level examination. - Attested photocopy of provisional certificates of H.S.C/'A' level examination. - Mark sheet of S.S.C & H.S.C examination or equivalent examination. - Six copies of recent passport size photograph of the candidate. - A character certificate from the Head of the Institute last attended. - A nationality certificate from commissioner or by Notary Public. - Photocopy of the Passport. - Any other Certificate for extra curricular activities. - Original documents must be submitted at the time of final admission.oThe duration of B.D.S Course is four years, with professional examination in each year.The course is followed by Honorary one year Compulsory Professional Practice in the form of Rotatory Internship.oClass attendance Minimum 75%.oAll the student will have to pay their tuition fees by the 7th day of every running month.oIf any student fails to pay the tuition fees by due date, the next date to clear the fees are between 8th to 25th of the same month with a fine of Tk. 200/-. If the fees still remain unpaid, then for each month Tk.300/- will be added with the regular fees.oAdvance post dated cheque are to be submitted at the time of admission to the accounts dept. completing total payments of development fees, Annual/Session fees, training and other miscellaneous fees.oStudent has to pay the monthly tuition fees till he /she passed the final B.D.S university examination.oFailure in payment in schedule time will be treated as defaulter and liable to be imposed 2% fine daily on the various fees.oBefore appearing any University Examination, students must have to clear all the dues before the month of exam.oThe name of the student will be struck off from the College register, if the fees remain unpaid for three months or more. The students then will have to seek re-registration on payment of full arear dues and also the re-registration fees.oStudents are expected to have maintained a high standard in their academic and private life. Lapses of moral values or addiction to drugs, gambling or any other crime/indiscipline are punishable offences.oNo student will be allowed to participate in any political activities or any types of demonstrations either within the college campus or outside.oThe management of Udayan Dental College, Rajshahi reserves the right to change or implement any new rules for the betterment of the institute.

Sl. No.Form No

Name of the Student

Campus - 1 :- House -1, Ward -7, Chandipur, Rajpara, Rajshahi. Phone: 0721774744, 01196191613, 01197235377, 01713229722Campus - 2 :- House - 454, Ward - 8, Kazihata, Rajpara, Rajshahi. E-mail : udayndentalcollege@gmail.com

Roll No

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UDAYAN

UDAYAN DENTAL COLLEGE, RAJSHAHI

M M Y YD D

Sex

Applicant's First Name

PARTICULARSOF THE APPLICANT

Middle Name Last Name

Date of Birth Blood GroupM F

Place of Birth Nationality National ID No. / Passport No

Mother's Name:Father's Name:

Mother's/ Guardian's Designation/Occupation :Father's/ Guardian's Designation/Occupation :

Mother's Work Address :Father's Work Address :

Permanent Address :Present Address :

Res:Tel: Mob :

E-mail

Academic Qualification :

Name of Exam Year of Passing Name of the Institute BoardGradePoint

Grade PointAverage (GPA)

Fax:

Ph: Ph:

Parents Yearly Income : Mail Delivery : Present Add. Permanent. Add. Work Add.

S.S.C/ '0' Level

H.S.C/ 'A' Level

Physics Chemistry Biology

Grade Grade GradeGrade Point Grade PointGrade Point

H.S.C.

S.S.C.

DECLARATIONThe information furnished above is true and correct The College authority can take any legal action against me if they find the above

information is false or incorrect. It is also understood that the College authority reserves the right not to send me to appear in the

University exam if my attendance is less than 75% and my schedule fees is not cleared or if I fail to pass the assessment Exam.

I, the undersigned solemnly declare that I shall obey the College rules and will not take part in any activities subversive of the state

or of College discipline. I also undertake that I shall not take part in any political activities either inside or outside the College.

Student's Signature

PHOTO

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Total Payable Amount for B.D.S Course(without tuition & exam fees)

Admission Fee

Developement Fee

Session Fee for four Academic year

Miscellaneous Fee for four Academic year

Caution Money (Refundable)

Training Fee

Others

Total Taka

Tk.

Tk.

Tk.

Tk.

Tk.

Tk.

Tk.

Tk.

SCHEDULE OF PAYMENT

Payment at the time of Admission

Admission Fee TK. to be paid on .

Development Fee TK. to be paid on .

Annual/Session Fee (for 1st Academic year) TK. to be paid on .

Miscellaneous Fee (for 1st Academic year) TK. to be paid on .

Caution Fee (Refundable) TK to be paid on .

For 2nd Academic year Tk. to be paid on .

For 3rd Academic year Tk.. to be paid on .

For Final Academic year Tk.. to be paid on .

1st Installment Tk. to be paid on .

2nd Installment Tk.. to be paid on .

Tuition fee 1st & 2nd year per Month TK.

Tuition fee 3rd & Final year per Month TK.

Annual/Seesion Fee :

Miscellaneous Fee :

In Service Training Fee

Monthly Tuition Fee :

DECLARATIONI ,the undersigned father/mother of

do hereby undertake all the responsibilities of my ward regarding all the payment of various fees for the B.D.S Course mentioned above. I will regularly pay the monthly tuition fees and the Centre fee for exam for my ward till he/she pass final B.D.S. University Examination. It is also understood that failure in payment in schedule time will be treated as defaulters and I will be liable to pay 2% fine daily on the various fees.

I will abide by the rules and regulations of the Udayan Dental College, Rajshahi. I will have no objection, if the College authority changes or implements new rules for the betterment of the institute.

Signature of Father / Mother / Guardian witness

For 2nd Academic year Tk. to be paid on .

For 3rd Academic year Tk.. to be paid on .

For Final Academic year Tk.. to be paid on .

UD

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* VAT APPLICABLE

* VAT APPLICABLE

* VAT APPLICABLE

* VAT APPLICABLE

DEN

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UDAYAN

SI. No.From No. College Code Roll No. Registration No.

Documents received :

1.Certificate of S.S.C/'O' Level. Exam.

2.Provisional Certificate of H.S.C/'A' Level Exam.

3.Mark sheet of S.S.C/'O' Level Exam.

4.Mark sheet of H.S.C/'A' Level Exam.

5.Testimonial of H.S.C./'A' Level Exam.

6.A Character Certificate from the head of the institute last attended.

7.Citizenship Certificate

8.Photocopy of the Passport

9.Any other Certificate for Extra curriculum activities

10.Total Grade/Marks (S.S.C +H.S.C) / ('O' + 'A') Level

Mark sheet & all the certificate is verified & found correct

Original

Original

Original

Original

Original

Original

Original

Original

Original

Original

Duplicate

Duplicate

Duplicate

Duplicate

Duplicate

Duplicate

Duplicate

Duplicate

Duplicate

Student Relation officerDate of Admission

Name & Address of the Local Guardian

Grade/Marks Obtained in Admission Test :

Medical Test done on :

Special Note:

Candidate Referred by

Admin. Officer Executive Director Principal

For Office Use only

Hostel Facilities Y N