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    Admission Form

    Uploaded by

    Yasin Ahmed
    The document is an admission form for Bangladesh Institute of Medical Science (BIMS) that collects personal information such as name, address, contact details, education qualifications, and course of interest. It lists various ultrasound and medical certificate courses offered by BIMS and asks the applicant to tick the courses of interest. It also includes a declaration stating the applicant will abide by institute rules and accepts all terms and conditions in the prospectus.

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

    Admission Form

    Uploaded by

    Yasin Ahmed
    154 views1 page
    The document is an admission form for Bangladesh Institute of Medical Science (BIMS) that collects personal information such as name, address, contact details, education qualifications, and course of interest. It lists various ultrasound and medical certificate courses offered by BIMS and asks the applicant to tick the courses of interest. It also includes a declaration stating the applicant will abide by institute rules and accepts all terms and conditions in the prospectus.

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    © © All Rights Reserved

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    The document is an admission form for Bangladesh Institute of Medical Science (BIMS) that collects personal information such as name, address, contact details, education qualifications, and course of interest. It lists various ultrasound and medical certificate courses offered by BIMS and asks the applicant to tick the courses of interest. It also includes a declaration stating the applicant will abide by institute rules and accepts all terms and conditions in the prospectus.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    154 views1 page

    Admission Form

    Uploaded by

    Yasin Ahmed
    The document is an admission form for Bangladesh Institute of Medical Science (BIMS) that collects personal information such as name, address, contact details, education qualifications, and course of interest. It lists various ultrasound and medical certificate courses offered by BIMS and asks the applicant to tick the courses of interest. It also includes a declaration stating the applicant will abide by institute rules and accepts all terms and conditions in the prospectus.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Bangladesh Institute of Medical Science (BIMS)

    N-23, Nurjahan Road, Mohammedpur, Dhaka - 1207, Bangladesh, Phone-+ 88 02-8115 932, Call: 01714301925,
    Fax: + 88 02-9123 813, E-mail : [email protected], Web: www.bims-bd.com
    ADMISSION FORM
    Name (Block Latter): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Sex: . . . .. . . . . . . . . . . . Religion: . . . . . . . . . . . . . . . . . . . . . . . . . . Date of Birth: . . . . . . . . . . . . . . . . . . Father's or
    Guardian's Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . .
    Mother's Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . Mailing
    address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Permanent address: . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Phone no. (with country & city code):. . . . . . . . . . . . . . . . . . . . . . .Cell No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Qualification: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Year of Qualification: . . . . . . . . . . . . . . . . . . . . . Name of the college/University form which qualified
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Course in which interested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Experience
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Course fee paid (Please tick) Cash /DD / Pay Order / Bank Draft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in word. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Declaration : I solemnly declare that I shall abide by the Institute's rules, discipline & will not take part in any activities
    subversive to the Institute. I accept all terms & conditions mention in the prospectus.
    Signature & Date
    Diploma in Medical Ultrasound (DMU)
    Certificate in Medical Ultrasound (CMU)
    Certificate in Trans Vaginal Sonogram (T.V.S)
    Certificate in Color Doppler & Echocardiography (CCDE)
    Certificate Saline Infusion Sonogram (S.I.S)
    Certificate in Gynae & Obstetrics (CGOB)
    Short Med ical Ultrasound Training Course
    Advance Overseas Ultrasound Training
    One month Intern ship on Ultrasound
    Certificate in Assisted Reproductive Technology (CART)
    Please fill up the form and (Tick)

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