application form for admission to bachelor in prosthetics...
TRANSCRIPT
APPLICATION FORM
for
Admission to
Bachelor in
Prosthetics & Orthotics
Rehabilitation Research and Training
Centre Bengaluru, India
Internationally Recognised Training
Institute in India
RAJIV GANDHI UNIVERSITY OF
HEALTH SCIENCES, KARNATAKA
REHABILITATION COUNCIL
OF INDIA, NEW DELHI
AFFILIATION & RECOGNITION:
(Overseas Students)
Eligibility for admission:
Overseas student: have passed “A” level with 50% conducted by any Boards/ Councils/
Intermediate Education established by their respective country recognised as equivalent to
10+2 in science by the Rajiv Gandhi University of Health Science with physics, chemistry and
mathematics/biology
Age: Applicant should have completed the age of 17 years at the time of admission
Method of Selection:
Selection is based on Merit and entrance written test marks. ( Written test questions contains
12th Standard Physics, Chemistry, Biology, Mathematics and English)
ELIGIBILITY & ADMISSION PROCEDURE
MOBILITY INDIA
Important Month:
1. Admission Opens: January
2. Applying for eligibility certificate : April-Sept (follow university notification)
3. Entrance Test (written at the institution or over phone, Skype) : Jan-Sept
4. Confirmation of admission : April-Sept (once institution satisfied with candidature)
5. Remittance of course fee: Sept (Cash/Demand Draft/online payment is acceptable)
st6. Commencement of Course: 1 week of Oct (follow university notification)
Admission Confirmation:
The eligibility certificate from Rajiv Gandhi University of Health Science, Karnataka
(RGUHS) is a pre-requisite to seek admission to the Bachelor in Prosthetics & Orthotics
course. RGUHS provides the eligibility certificate for foreign students in conformity with the
guidelines set by the Association of Indian Universities (AIU) House 16, Comrade Indrajit
Gupta Marg (Kotla Marg), New Delhi 110002.
If RGUHS is not convinced about the requisite qualification of a foreign candidate is equivalent
to the +2 stage of India, the university requires “Equivalence Certificate” from Association of
Indian Universities (AIU). To apply for the “Equivalence Certificate”, visit www.aiuweb.org
Candidates who possess the requisite qualification from foreign universities or Boards of
Higher Education recognised as equivalent to the +2 stage of India by the Association of Indian
Universities (AIU), New Delhi, are eligible for admission to this course.
It requires a minimum period of one month to process application for the eligibility certificate.
Candidates are advised to apply well in advance. Mobility India will not be responsible for any
delay in getting eligibility certificate by RGUHS
Where eligibility process could not be performed by the candidate due to different
location, Mobility India can facilitate on behalf of the candidate.
ELIGIBILITY & ADMISSION PROCEDURE
MOBILITY INDIA
Application Fees:
Application can be obtained by hand from Mobility India on payment of INR 500/- for Indian
student & USD 10 for foreign student or by mail or download from www.mobility-india.org and
submitted duly filled application along with demand draft drawn in favour of Mobility India
payable at Bengaluru or Bank transfer to Mobility India account.
Documents to be attached to the application (2 copies each):
Documents to be attached to the Eligibility certificate application:
DO NOT SEND ANY ORIGINAL DOCUMENTS ALONG WITH THE APPLICATION FORM
l Photocopy of 10 years and 12 years of schooling certificate and mark sheet attested by
competent authorities/government notary/government gazetted officer.
l Photocopy of Transfer and Migration Certificate attested by competent
authorities/government notary/government gazetted officer.
l Photocopy of Character certificate from School/college from where candidate has passed
l Date of Birth Certificate and Nationality Certificate Photocopy of Passport,
l Equivalence certificate from Association of Indian Universities (AIU) wherever applicable
l Rajiv Gandhi University of Health Sciences application for issue of eligibility certificate (for
pursuing graduate degree)
l Three stamp size Photos duly signed by the candidate (Description: Size 2cm X 2.5 cm,
Color of background: white)
l 2 passport size photos (Description: Size 3.5 x 3.5 cm, Colour of background: white) l Physical fitness certificate from Government Hospital Doctor
l LABORATORY TESTS- Blood- Ag Hbs (Hepatitis B), Ac HCv (Hepatitis C), Tuberculin
Skin test (Mantoux) and Complete blood count by Government Hospital doctor
l Sponsorship certificate from the sponsor outlining what costs they will cover and confirming
they will fund the entire course (If applicable)
Follow the same which is mentioned under “Documents to be attached to the application”
Medium of Instruction: English
Eligibility Certificate fees: INR 5500/- for SAARC, USD 350 for other countries
SUBMIT ORIGINAL CERTIFICATES AFTER ADMISSION CONFIRMED TO SUBMIT
FOR UNIVERSITY VERIFICATION
ELIGIBILITY & ADMISSION PROCEDURE
MOBILITY INDIA
All the admissions made will be provisional and if at any stage during the entire course it is
found that the candidate has submitted false information in the application form, his/her
candidature for the course will be cancelled and disciplinary action may be taken against
him/her as the institutional rules. The institution reserves the right to cancel the admission of
any student for a specific reason.
Cancellation of Admission:
Address to Post your duly filled in application:
Mail ID to send your duly filled in application:
Manager
Academic Administration
Mobility India
Refundment:
If candidate wanted to cancel his/her admission after the course fee payment or
commencement of the classes, refundable of course fees will be subject to institution decision
and student cannot claim.
1st & 1st ‘A’ Cross, J.P. Nagar, 2nd Phase, Bangalore - 560 078.INDIA : +91-80-26492222 / 26597337 / 26491386 - Ext-125 (Academic) : +91-80-26494444 Ext. - 110
Rehabilitation Research and Training Centre
* Do not send the eligibility and admission procedure page no 1 to 7 with application
Instruction to fill the application form:
l Forms must be filled in applicant’s own handwriting
l Use only BLACK OR BLUE Hi-Tec Point type pen to fill up the form
l Applicants must paste their most recent colour photo graph (not older than 3 months)
l Overwriting, striking off or erasing in the form may lead to rejection and should be avoided
l Any discrepancy in the statement and /or submission of incomplete forms will lead to
rejection of application/cancellation of admission
l Wherever it is not applicable Write “NA”. don't leave blank box
Applicants are required to submit photocopies of marks cards, certificates or any other
documents and must ensure that:
l The photocopies are taken on A4 size paper only
l The print/scan is clear, legible and readable
l Both sides are photocopied if the original marks care is printed on both sides
Candidates from Overseas shall have passed “A” level conducted by any Boards/ Councils/ Intermediate Education
established by their respective country recognised as equivalent to 10+2 in science by the Rajiv Gandhi University of
Health Science with physics, chemistry and mathematics/biology will be eligible for admission to this course
Only candidates who have the requisite qualification from foreign universities or Boards of Higher Education recognised
as equivalent to the +2 stage science of India by the Association of Indian Universities (AIU), New Delhi are eligible for
admission to Rajiv Gandhi University for Health Science, Karnataka. If required, candidates will be asked to obtain the
“Equivalence Certificate” from Association of Indian Universities (AIU) New Delhi.
The following foreign examinations have been recognised as equivalent to the + 2 stage of an Indian Board
www.aiuweb.org:
Eligibility (Qualification Exam passed) for admission:
COUNTRYQUALIFYING EXAMINATION/CERTIFICATE EQUIVALENT TO THE +2 STAGE OF AN
INDIAN BOARD
AFGHANISTAN 12 years Secondary school Certificate examination of the ministry of education
AUSTRALIA 12 years Secondary Stage Examination conducted by various Provinces in Australia
BANGLADESH Intermediate/ Senior Secondary/ Higher Secondary of the approved Boards
BHUTAN Intermediate/ Senior Secondary/ Higher Secondary of the approved Boards
BAHRAIN 12 years General Secondary Education Certificate of the Ministry of Education
CHAD, GABON 12 years Baccalaureate Certificate
CANADA 12 years Secondary Stage Examination conducted by various Provinces in Canada. Candidate
having passed Ontario secondary school Diploma of the ministry of Education, Ontario should
have acquired minimum 6 (six) “U/M” (university preparatory courses)
DEMOCRATIC REPUBLIC
OF CONGOEXAMEN D “ETAT of the ministry of Primary, secondary and professional education
EQYPT 12 years General Secondary Education Certificate of the Ministry of Education
ETHIOPIA12 years Secondary Stage qualification of National Examination Board of the Ministry
of Education
FRANCE 12 years Baccalaureate Certificate
GERMANY Abitur
HONG KONG GCE/ IGCSE/ GCSE examinations of the approved British Examining Bodies in Singapore
with passes in 5 subjects in A, B, C grades including English at 'Ordinary Level' and 2/3
subjects at 'Advanced Level' has been equated with +2 stage qualification. For admission
to professional courses – medical. Advanced level passes in Physics, Chemistry, Biology/
Mathematics and English are essential besides 5(Five) passes at GCE 'Ordinary Level’
INDONESIA 12 years Secondary Stage qualification
IRAN Pre university certificate examination of the ministry of education
JORDAN 12 years General Secondary Education Certificate of the Ministry of Education
JAPAN 12 years Secondary Stage qualification
KOREA 12 years Secondary Stage qualification
KUWAIT 12 years General Secondary Education Certificate of the Ministry of Education
KENYA 2 years Secondary Stage qualification of National Examination Board/ Council of the
Ministry of Education/12 year Kenya Certificate of secondary education examination with
more than 5 (five) subjects in the grade A” , B” C” of the Kenya national examinations
council
MALAYSIA 12 years STPM examination of Malaysia
MAURITIUS GCE/ IGCSE/ GCSE examinations of the approved British Examining Bodies in Singapore
with passes in 5 subjects in A, B, C grades including English at 'Ordinary Level' and 2/3
subjects at 'Advanced Level' has been equated with +2 stage qualification.
For a dmission to professional courses – medical. Advanced level passes in Physics, Chemistry,
Biology/ Mathematics and English are essential besides 5(Five) passes at GCE 'Ordinary Level'
NEPAL Intermediate/ Senior Secondary/ Higher Secondary of the approved Boards
NIGERIA 2 years Secondary Stage qualification of National Examination Board/ Council of the
Ministry of Education/12 year Senior school certificate examination of West African
examination council (WACE) in A, B, C grades on a scale of 1-4 (A-1, B-2, B-3, C-4)
OMAN 12 years General Secondary Education Certificate of the Ministry of Education
OTHER GULF COUNTRIES 12 years General Secondary Education Certificate of the Ministry of Education
PAKISTAN Intermediate/ Senior Secondary/ Higher Secondary of the approved Boards
REPUBLIC OF IRAQ 12 year secondary school certificate examination of the ministry of education
SUDAN12 years Secondary Stage qualification of National Examination Board of the Ministry
of Education
SWITZERLANDInternal Baccalaureate Diploma awarded by Internal Baccalaureate organization
Geneva
SRI LANKA GCE 'Ordinary and Advanced' level examination of the Department of Examination,
Government of Sri Lanka
SAUDI ARABIA 12 years General Secondary Education Certificate of the Ministry of Education
SOCIALIST REPUBLIC
OF VIETNAM12 years Secondary Stage qualification
SINGAPORE GCE/ IGCSE/ GCSE examinations of the approved British Examining Bodies in Singapore with passes in 5 subjects in A, B, C grades including English at 'Ordinary Level' and 2/3 subjects at 'Advanced Level' has been equated with +2 stage qualification.
For admission to professional courses – medical. Advanced level passes in Physics, Chemistry, Biology/ Mathematics and English are essential besides 5(Five) passes at GCE 'Ordinary Level’
UNITED ARAB EMIRATES 12 years General Secondary Education Certificate of the Ministry of Education
TANZANIA2 years Secondary Stage qualification of National Examination Board/ Council of the
Ministry of Education/Advanced certificate of secondary education examination with
minimum 2 (two) principal passes & 2 (two) subsidiary of the national examination council
TUNISIA 12 years Baccalaureate Certificate
UGANDA 2 years Secondary Stage qualification of National Examination Board/ Council of the Ministry of Education/ Advanced certificate of education examination with minimum 2 (two) principal passes & 2 (two) subsidiary of the Uganda examination Board
UNITED KINGDOMGCE/ IGCSE/ GCSE examinations of the approved British Examining Bodies in Singapore with
passes in 5 subjects in A, B, C grades including English at 'Ordinary Level' and 2/3 subjects at
'Advanced Level' has been equated with +2 stage qualification.
For admission to professional courses – medical. Advanced level passes in Physics, Chemistry,
Biology/ Mathematics and English are essential besides 5(Five) passes at GCE 'Ordinary Level’
UNITED STATES
OF AMERICA (USA)
12-year High School Diploma awarded by the accredited American School/ International
Schools in other countries following American pattern of education.
YEMEN ARAB REPUBLIC
OTHER COUNTRIES
12-years Secondary Stage qualification
Contact: Association of Indian Universities (AIU)
High School Diploma awarded by the American Schools in other parts of the world should be accredited either by
the state departments of education or by Six Regional accrediting agencies in USA
l Middle States/New England/North Central/Northwest/Southern/WesternAssociation of school and colleges
(AIU don't accepts High School Diploma pursued through ONLINE / DISTANCE Mode)
Age Limit: The candidate should have completed the age of 17 years on or before 31st July.
APPLICATION FORM
PERSONAL INFORMATION
ACADEMIC YEAR TO
Please fill up the application form in BLOCK LETTERS only
1. Applicant Name: (As per school records)
2. Gender: Male Female 3. Date of Birth: 3A. Age: years Day Month Year
4. Father’s Name:
8. Address for
Communication:
PIN:
Contact No:
Contact No:
Country:
E-mail ID:
E-mail ID:
6. Father / Mother’s Occupation: 7. Blood Group:
5. Mother’s Name:
9. Are you Person with Disability, If yes: write your disability & assistive device you use
10. Do you require hostel in campus for the First year : NoYes
Please affix
stamp size
(2cm x 2.5cm)
photograph
hereBACHELOR IN PROSTHETICS 1AND ORTHOTICS - 4 / years2
(Overseas Students only)
12. Academic Information
11. In Emergency:
B. Contact No: C. Relationship with student:
A. Contact Person Name:
Name of the qualifying
Examination passed
Country - qualifying
Examination passed
Month & year of qualifying
Examination passed
Name of the board/university
Which conducted examination
Registration No:
Marks Secured at the Qualifying Examination:
In case Grades are awarded in the subjects at the qualifying examination, the equivalent
marks for each grade should be furnished.
Language & Optional
Subjects Passed
Maximum
Marks
Minimum
Marks To Pass
Marks
Obtained
English
English
Physics (P)
Physics (P)
Chemistry (C)
Chemistry (C)
Biology (B)
Biology (B)
Mathematics (M)
Mathematics (M)
Language & Optional
Subjects Passed
Grade
AwardedEquivalent
Marks Of The Grade
Mean /average
Marks Of The Grade
Example :
Grade
Candidate should furnish the
table showing the equivalent
marks for each grade issued
by the examination conducting
authority
A
B
91- 100
81- 90
95
85
Equivalent
MarksAverage
Note:
In case Credits are awarded in the subjects at the qualifying examination,
the equivalent marks for each credit should be furnished.
DD/MM/YY DD/MM/YYIssuing Authority Place Of Issue
Nationality Passport Number Date Of Issue Date Of Expiry
Passport Details
Example :
Maximum
Credit
Credit
Awarded
Candidate should furnish the
table showing the equivalent
marks for each credit issued
by the examination conducting
authority
5 2
5 3
50
65
Equivalent
Marks
Note:
Language & Optional
Subjects Passed
Credit
Awarded
Minimum
Credit
Maximum
Credit
Equivalent
Marks Of The Credit
13. If your study is sponsored by any individual/funding agency, please specify funder details
Name
& address:
Contact No
& Mail ID:
14. If you are a staff/Identified by any non government organisation/business entity at present
please specify
Name
& address:
Contact No
& Mail ID:
English
Physics (P)
Chemistry (C)
Biology (B)
Mathematics (M)
DECLARATION
DATE
STUDENT’S SIGNATURE
FATHER / MOTHER / GUARDIAN’S SIGNATURE
I hereby solemnly and sincerely affirm that I fulfil the eligibility conditions and the statement made
and information furnished in the application form are correct and also I have not withheld any
information. If it is later found that any information furnished herein is fraudulent, incorrect or untrue,
I am liable to prosecution and that my admission to the course is liable to be cancelled.
DOCUMENTS TO BE ATTACHED TO THE APPLICATION (2 copies each):
Cash/DD DD No.
Bank Name.
Bank Name.
Date.
Date.
Application Fees: INR 500/- (Indian), INR 500/- (Foreigner)
Transaction No.Bank transfer:
l Photocopy of 10 years and 12 years of schooling certificate and mark sheet attested by
competent authorities/government notary/government gazetted officer.
l Photocopy of Transfer and Migration Certificate attested by competent
authorities/government notary/government gazetted officer.
l Photocopy of Character certificate from School/college from where candidate has passed
l Date of Birth Certificate and Nationality Certificate Photocopy of Passport,
l Equivalence certificate from Association of Indian Universities (AIU) wherever applicable
l Rajiv Gandhi University of Health Sciences application for issue of eligibility certificate (for
pursuing graduate degree)
l Three stamp size Photos duly signed by the candidate (Description: Size 2cm X 2.5 cm,
Color of background: white)
l 2 passport size photos (Description: Size 3.5 x 3.5 cm, Colour of background: white) l Physical fitness certificate from Government Hospital Doctor
l LABORATORY TESTS- Blood- Ag Hbs (Hepatitis B), Ac HCv (Hepatitis C), Tuberculin
Skin test (Mantoux) and Complete blood count by Government Hospital doctor
l Sponsorship certificate from the sponsor outlining what costs they will cover and confirming
they will fund the entire course (If applicable)
OFFICE USE ONLY
OFFICE USE ONLY
On behalf of Mobility India, I have verified all the details and certificate copies furnished by the candidate and found true.
On behalf of Mobility India, I have verified all the details and certificate copies furnished by the candidate and found true.
DATE
DATE
VERIFIED BY
VERIFIED BY
NAME
NAME
SIGNATURE
SIGNATURE
Remarks
Remarks
Application No:
Application No:
Roll No:
Roll No:
OFFICE USE ONLY
OFFICE USE ONLY
1. Please state why you would like the applicant to attend this particular training programme.
2. How will you support and supervise the applicant in their job following their completion of the training programme?
3. What facilities/manpower/ infrastructure do you currently have? E.g Prosthetic/ Orthotic Workshop/Unit, Therapy Unit, CBR programme.
4. Kindly mention the approx. number of persons with disabilities the participant has worked with before training and/or will be working after training? Please mention the type of disabilities.
TO BE COMPLETED BY THE PARENT ORGANISATION (COMPULSORY)
(If selected student is an existing employee of your organization)
This is to certify that the applicant is our Employee for the past years. The furnished information about the applicant is true.
(If selected student is a fresh candidate)
This is to certify that the applicant is newly selected to undergo the above said course. The furnished information about the applicant is true.
Date:
Date:
Organisation Seal
Organisation Seal
Signature of the official authority
Signature of the official authority
DECLARATION BY THE PARENT ORGANISATION
I……………………………………………………………………………………................, have read the
rules and conditions for my admission into ……………………………………..
1. I do hereby promise that I will not:
a. Cause any damage to any property of the College and Hostel such as Benches, Switchboards, Furniture, Laboratory equipments, Sports equipment etc.
Any public property in the vicinity of the College or elsewhere
b. Deface the Desks, Benches, Chairs, Walls of the Hotel/ Class-Rooms, Blackboards, Toilet, Walls of the college etc., with any writing whatsoever.
2. I will regularly attend all my class throughout the year and I will maintain a minimum of 85% of attendance as per the rules. If for any unforeseen reason I am not able to attend the classes for a long time without prior intimation to the Principal, I shall submit a valid explanation at the earliest. I am aware that if 85% attendance is not maintained in all the subject, I will no be allowed to appear for the Annual Examination.
3. I will appear for all Terminal Testsand Examinations conducted by the College, with out fail.
4. I will submit all the assignments, Record books, Home Work etc.. in time for the purpose of continuous evaluation. I shall make an earnest attempt to achieve academic improvement in all the subjects throughout the year.
5. I shall attend the Preparatory Examination, if I fail to do so, I may be debarred from appearing for
the Public Examination.
6. I shall keep up the good name of the College in all my thoughts, behaviour and actions
7. I will be fully committed to my studies and will maintain absolute silence in the class and shall not disturb any class by indulging in talks or moving in and out of classroom when classes are in progress.
8. I shall not indulge in ragging or in any other kind of misbehaviour .
9. I shall implicitly accept the decision of the Management as final in all matters of discipline.
10. I will not use any obscene or unparliamentarily language anywhere, especially with teaching staff whom I shall respect
Place:………….........……
Date:……………...........…. Student Signature
DECLARATION BY THE STUDENT
To
The Principal