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    Application Form BSPH

    Uploaded by

    Saleem Chishti

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Application Form BSPH

    Uploaded by

    Saleem Chishti
    2 views6 pages

    Copyright

    © © All Rights Reserved

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    DOCX, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
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    Download as docx, pdf, or txt
    2 views6 pages

    Application Form BSPH

    Uploaded by

    Saleem Chishti

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 6

    AL-SHIFA SCHOOL OF PUBLIC HEALTH

    PAKISTAN INSTITUTE OF OPHTHALMOLOGY


    AL-SHIFA TRUST, RAWALPINDI

    Form No. Photograph

    APPLICATION FORM

    BS (PH) Programme

    Al-Shifa School of Public Health

    Al-Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi

    Tel: 051-5487820-24; http://sofph.alshifaeye.org/

    SEMESTER SPRING/FALL 20____

    1
    1. SECTION 1: PERSONAL INFORMATION

    FULL NAME: MR. /MS.

    (As on Matriculation certificate)

    FATHER’S NAME:

    SEX: MALE FEMALE DATE OF BIRTH: / /

    (As on Matriculation certificate)

    National Identity Card No.

    (Passport No for foreign Students)

    DOMICILE (PROVINCE): NATIONALITY:

    PERMANENT ADDRESS:

    PHONE NO: MOBILE:

    (with area code)

    POSTAL ADDRESS:

    PHONE NO: MOBILE:

    (with area code)

    2
    OFFICE NO: FAX NO:

    (with area code) (with area code)

    EMAIL:

    2. SECTION 2: ADDITIONAL SKILLS

    Please note that the following questions are NOT part of our selection criteria for the first
    phase of short-listing; however please note that the Al-Shifa School of Public Health, PIO will
    be interested to know about these skills in the interviews after the first phase is complete.

    ENGLISH LANGUAGE SKILLS

    How do you rate your English language skills?

    POOR FAIR GOOD EXCELLENT

    SPEAKING

    WRITING

    How do you rate your computer skills?

    POOR FAIR GOOD EXCELLENT

    MICROSOFT
    WORD
    MICROSOFT
    POWER
    POINT
    MICROSOFT EXCEL

    ANY OTHER SOFTWARE (SPECIFY)

    3
    3. SECTION 3: QUALIFICATIONS
    List all the School & Colleges attended in reverse chronological order. Begin with the most
    recent.

    NAME OF PLACE, DATES ATTENDED DEGREE PASSING MARKS TOTAL


    INSTITUTION COUNTRY NAME YEAR OBTAINED MARKS
    FROM TO

    4. SECTION 4: SIGNATURE FORM


    4
    If you are offered admission to the BSPH Course, how do you plan to pay for it?

    EMPLOYER: SELF: OTHER (SPECIFY):

    PAYMENT SCHEDULE

    LUMP SUM SEMESTER WISE

    I affirm that the information on this application form and any additional material that I submit is
    complete and accurate to the best of my knowledge. I understand that furnishing false or incomplete
    information may be cause for denial of admission, cancellation of registration, or revocation of
    degree.

    APPLICANT’S SIGNATURE: DATE:

    NOTE: All applicants are required to send:

    1. Complete filled application form handwritten or typed.

    2. Two complete ATTESTED/VERIFIED sets of all documents (Last Degrees must be


    verified, Domicile, ID Card, 2 passport size photos)

    3. Application processing fee of Rs. 2,000/- (non- refundable) in the form of pay order or
    bank draft made to “Al-Shifa Trust Eye Hospital, Rawalpindi”

    4. Can be submitted in person or through TCS/Courier services at the address given below:

    BS (PH) Admission,
    Al-Shifa School of Public Health,
    Pakistan Institute of
    Ophthalmology, Al Shifa Trust
    Eye Hospital, Jhelum Road,
    Rawalpindi.

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