Rajasthan Institute of Local Self Government

Diploma in Public Health and Sanitary Aids Online Admission Form

(Please read carefully and fill out the correct information below to submit your online form)

Course

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Medium

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General Details

First Name

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Last Name

Father's Name

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Mother's Name

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Date Of Birth

Correspondence Address

Address Line-1

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Address Line-2

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Address Line-3

State

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District

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City/ Village

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PinCode

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Permanent Address

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Address Line-2

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Address Line-3

State

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District

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City/ Village

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PinCode

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Education Qualification

S.No

Class

Subject

Board/University

Per(%)

Year

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Secondary

Your Subject

Your Board

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Sr. Secondary

Your Subject

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(Internet Result Copy)

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Your Subject

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Photo & Signature Details

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Signature

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DECLARATION

I Hereby declare that all Statements made & information given in this application are ture to the best of my knowledge and belief and in the event of any information found false or incorrect, my candidature is liable to be cancelled and shall abide by all the rules & regulations of the college . The institue is free to take any legal action against me.