DJDC Admission Form

Admission Form

Please fill in the form below.
Full Name*

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Father's Name

First NameLast Name
Mother's Name

First NameLast Name
Address*

Address Line 1

Address Line 2

CityState

Pin / Postal Code
Phone Number*
Candidate Phone Number

Area CodePhone Number
Parents Phone No

Area CodePhone Number
E-mail
Make sure email is correct since all updates will be sent here
Course *

BDSMDSDHDMBAMSBSc. NursingGNMANMD.PharmaB. Pharma
Have you given NEET?*

YesNo
Current NEET Status*

QualifiedNon-Qualified
NEET Score
Upload your NEET Scorecard

Upload a File
Screenshot / PDF of NEET Scorecard Cancelof
MDS Departmental Preferences

OrthodonticsOral SurgeryPeriodonticsPedodonticsOral PathologyCommunity DentistryConservative & EndodonticsOral MedicineProsthodontics
How did you hear about us? *

Google AdsNewspaper AdFacebookFriends/FamilySMSRadio Ads
Category

GeneralOBCSCSTPwDEWS
Enter the message as it's shown*
Can we use these details to contact you via email, phone or text message to share information such as fees structure and admission process?

YesNo
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