Lenora Institute of DentalSciences

(Recognized by DCI / Govt. ofIndia Form No :

Affiliated to Dr.NTR University of Health Sciences,Vijayawada) NH-16,

Rajanagaram, Rajahmundry-533294,A.P.

Tel. No.:0883-2484492; Fax :0883-2484493

Email:

ImportantInstructions

  • PleaserefertotheadmissionguidelinesintheProspectusand/ortheWebportal before filling the form and takingadmission.
  • No column should be left blank. Write N.A. if notapplicable.
  • All the details should be filled in BlockLetters
  • Applicationformmustbefilledin,signedbythecandidatewithblue/blackpenandduly countersignedby theparent/guardian.
  • Filled application forms shall be submitted in person to the Admission Cell, Office of the Principal, Lenora Institute ofDental Sciences, NH-16, Rajanagaram, Rajahmundry-533294, Andhra Pradesh on or before date notified by in person or email or bypost.
  • Applicationsunaccompaniedbyrequiredcertificatesorapplicationswithincompleteentriesandineligibleapplicationsshall stand rejected automatically. Please do not leave any column blank. Where information is NIL write NO /NIL.
  • Applicationsofthecandidates,whofurnishincorrectinformation,enclosefalse/incorrectcertificateorapproachthrough agents shall stand rejectedautomatically.
  • Application shall be filled in English by the candidate in his / her ownhandwriting.
  • The cover must be super scribed “For Admission into I year MDS course –2016--2017”.
Institution: LENORA INSTITUTE OF DENTAL SCIENCES,RAJAHMUNDRY
Programme:Stream(Ifapplicable) (For details, refer to the admission prospectus or visit )
BDS Marksobtained:
Entrance Test Details: Dr. NTRUHS MDS Entrance Test H.T.No.RANK.
Marksobtainedinpersonalinterview(forofficeuseonly)

1.PersonalDetails

(PleasenotethatthenamegivenonapplicationformmustbesameasitappearsontheclassXcertificate)

Name: Gender: M/F

Date of Birth:(DD/MM/YY)//Age (as on 1 July16)Nationality:

Father’sName:Mother’sName:

2.Educational Qualification

Exam Passed / Stream(Arts, Comm./ Scienceor anyother, Please specify) / Mention thesubject you have studiedas per theeligibility criteria(mentioned in theadmission prospectus) / University/ Board/ Council / Mediumof instruction / %Obtained (inall compulsory subjects)
*ifresult awaitedwrite R.A. / Remarks / Verification
( bydealing official)
(not tobe filledby candidate)
Matriculation
10+2
Diploma / 2yrs
3yrs
Graduation
PGDiploma / 1yr
2yrs
P Gdegree
Anyother

3.Dr NTR UHS MDS Entrance testPARTICULARS:

H.T.NO.RankTotalMarks

4.Doyouwanttoavailhostelfacility?(Optional)YesNo

If yes (P.) - ThreeSeaterFourSeaterFiveSeater/Dormitory

5. Do you wanttoavailbusfacility?(Optional)YesNo

If yes (P.) -CityBoardingPoint

7.PermanentAddress:Correspondence Address (If different from permanentaddress)

TelephoneNo:

FATHER
Residence ( with STD Code) Office ( with STD Code) Mobile E-mailID / MOTHER
Residence ( with STD Code) Office( with STD Code) Mobile E-mailID
Self-MobileSelf-E-mailID:

8.Haveyoueverbeendisqualified/punishedforindisciplineorforusingunfairmeansorotherwise?Yes_No

if yes , give details:…………………………………………………………………………………………………………………......

9.Haveyoueverbeenconvictedinanycasebycourtoflaworisthereanycriminalcasependingagainstyou?Yes_No

10.Documents to be submitted along with theapplication:

a.Certified copy of the SSC or any equivalent examination showing date of birth and other particulars of thecandidate

b.Copy of Intermediate Marks Memo

b.Permanent or Provisional Degreecertificate.

c.BDS Registration from state dentalcouncil.

d.Migration certificate.( If UG is not fromDRNTRUHS).

e.DR NTRUHS MDS ENTRANCE TEST Hall Ticket and Rank Card for ascertainingmerit

f.GAP Certificate After UG (Ifany)

g.Community, NativityCertificate

h.Transfer Certificate ofBDS

i.Photographs with Name &D.O.B.

j.Bank Guarantees as per the Category ofAdmission

PHOTOCOPIES OF THE CERTIFICATES MUST BE ATTESTED BY GAZETTEDOFFICER.

RAGGING IS STRICTLYPROHIBITED

Signature of the Parent/GuardianSignature of the Candidate

ACKNOWLEDGEMENTCARD

Regn. No……………….… received application formfrom Dr.………..…………………………………………for admission into I year MDS course for 2016 - 2017ondt:……………………
OfficeSeal
DentalCollege,
.
Note: 1. Write your address on the Acknowledgementcard.
2. Quote the Regn. No. in futurecorrespondence. / To
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….

ACKNOWLEDGEMENTCARD

Regn. No……………….… received application formfrom Dr.………..…………………………………………for admission into I year MDS course for 2016 - 2017ondt:……………………
OfficeSeal
DentalCollege,
.
Note: 1. Write your address on the Acknowledgementcard.
2. Quote the Regn. No. in futurecorrespondence. / To
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….

ACKNOWLEDGEMENTCARD

Regn. No……………….… received application formfrom Dr.………..…………………………………………for admission into I year MDS course for 2016 - 2017ondt:……………………
OfficeSeal
.
Note: 1. Write your address on the Acknowledgementcard.
2. Quote the Regn. No. in futurecorrespondence. / To
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….