Admission / Registration Form

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Personal Information
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Name must be 1–50 characters and contain only letters
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Name must be 1–50 characters and contain only letters
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Name must be 1–50 characters and contain only letters
You are eligible (18+)
You must be at least 18 years old.
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Mobile number must be 10 digits and start with 6–9
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Email must be a valid email address
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Address must be 5–100 characters and can include letters, numbers, spaces, , . / # -
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City must be 2–50 characters and only letters
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State must be 2–50 characters and only letters
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Postal code must be exactly 6 digits
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Aadhar number must be exactly 12 digits
Enter your 12-digit Aadhar number without spaces
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Academic Qualification
Parent Information
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Name must be 1–50 characters and only letters
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Mobile number must be 10 digits and start with 6–9
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Aadhar number must be exactly 12 digits
✅ Valid file selected ❌ Please upload a valid JPG/PNG image (under 2MB)
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Name must be 1–50 characters and only letters
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Mobile number must be 10 digits and start with 6–9
Course Selection
Phlebotomist Technician
Learn blood collection techniques, sample handling, and laboratory procedures.
Emergency Medical Technician
Healthcare professional trained to provide immediate medical care to patients in emergency situations.
Other
I'm interested in other courses
You will be notified when suitable courses become available.
Additional Information

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