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Marian Institute of Health Care Management, Goa
Admission Form
APPLICATION FORM
POST GRADUATE PROGRAMME IN HEALTH CARE MANAGEMENT

These details will be used to communicate with you
Name* :
Date of Birth* :
Permanent Address* :
Phone* :
Mobile :

Correspondence Address

:
Phone :
Mobile :
Email id* :
 

Educational data (Please give the aggregate percentage obtained)
 
Year of Passing
Main Subject
Name of
School/ College/ University
Place / City
Percentage
 
High School  
High Secondary  
College (Degree)  

* Other academic Degrees/ Master degree/Diplomas (Specify).

Work Experience :
 
Organization
Place
Responsibilities
From: Month/Year
To: Month/Year
 

1. How did you come to know of the Programme?
 
2. What do you expect from this Program?
 
3. What factors are important to you when choosing a management programme?
 
I confirm that to the best of my knowledge, the information contained in this application is complete and accurate. The information provided in this application may be used as part of my student record
 
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Submit attested copies of the academic and experience certificates along with the form. (P.T.O)


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