The DHAN Academy T. Malaipatti, Thenkarai B.O., Mullipallam S.O., Vadipatti (TK), Madurai District 625 207, Tamil Nadu Cell: 96775 83405; email:
[email protected],
[email protected] Registration No : Application for 21th Post Graduate Diploma in Development Management (PGDDM) : 2020-2022 3rd Post Graduate Diploma in Community Health Management (PGDCHM) : 2020-2022 Instructions uPlease read carefully before completing. uFill in the application in your own handwriting with a ball-point pen uDon’t leave any box or column blank. Write NA if ‘Not Applicable’. uIncomplete application will not be considered. uLast date for the receipt of filled-in application is April 20, 2020. Name Mr. / Mrs. / Ms. (BLOCK LETTERS) Mailing Address (in Block Letters) Permanent Address / Home Address Name: Name: Father’s name: Course(s) being applied (Please Tick ( ü ) PGDDM PGDCHM 2. Personal Details 3. Details of application for one course registration fee payment ` 500 / Both Courses ` 1,000 Date Month Year Cash Paid on : ..................................................... Demand Draft DD No. : ..................................................... th Age : (as on 30 June 2020) Date : ..................................................... (in years, months and days) Bank & Branch : ........................................................................ Marital Status : Married Unmarried Bank deposit / transfer / through RTGS / NEFT Are you a first graduate from your family : Yes No Date of deposit / transfer : ...................................................