PGDFM for recent MBBS Graduates 2013 - Christian Medical College
PGDFM for recent MBBS Graduates 2013 - Christian Medical College
PGDFM for recent MBBS Graduates 2013 - Christian Medical College
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15. Name and address of<strong>Medical</strong> <strong>College</strong> fromwhere <strong>MBBS</strong> Coursewas completed.16. Name and Addressof <strong>Medical</strong> <strong>College</strong> fromwhere Internship wascompleted17. Year of <strong>MBBS</strong> CourseCompletion(Including Internship)18. Work experiencefollowing <strong>MBBS</strong> (if any)19. How do you think this course will benefit you?(Attach extra sheets, if needed)
20. What are your long term plans? (Attach extra sheets, if needed)21. Will you be able to complete the 2 contact courses of 7 days each, work through the 29course Module and complete an appropriate project as part of the course requirements?YesNoI do hereby declare that the in<strong>for</strong>mation given above is true to the best of my knowledge and belief.Date:Signature of the Applicant
<strong>PGDFM</strong> <strong>for</strong> <strong>recent</strong> <strong>MBBS</strong> <strong>Graduates</strong> <strong>2013</strong>CHRISTIAN MEDICAL COLLEGE, BAGAYAM, VELLORE – 632 002POSTGRADUATE DIPLOMA IN FAMILY MEDICINE <strong>for</strong> <strong>recent</strong> <strong>MBBS</strong> <strong>Graduates</strong>ADMISSION FOR(To be submitted only if selected <strong>for</strong> the course)Name of the Candidate:Date of Admission:Affix your <strong>recent</strong>passport sizephotoPaymentDetailsAmount DD No Date Name of the bankDate:SignatureEncl.:1. Two Photographs besides the one affixed on this <strong>for</strong>m2. DD <strong>for</strong> an amount of 5000/- (First Instalment)3. <strong>MBBS</strong> certificate or provisional pass certificate4. Recommendation letter from hospital where they intend to join
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