Enrolment

Participant Enrollment Form

Instructions:

  • Need to upload scanned copy/screenshot of passport size photo, MCI/NMC/State Council Certificate, MBBS Degree Certificate(in JPG, JPEG, PNG and PDF format).
  • Maximum size to upload the scanned/screenshot of documents would be 250KB.
  • All the mandatory fields (having *) are required.

SECTION I: PERSONAL DETAILS

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SECTION II: PLACE OF WORK

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SECTION III: RESIDENTIAL ADDRESS

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SECTION IV: MCI/NMC REGISTRATION DETAILS

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SECTION V: QUALIFICATION

College/Institution/Board/University Department Year of Passing Attach Proof
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SECTION VI: WORK EXPERIENCE

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Designation Organization From To

SECTION VII: FACULTY/CENTER PREFERENCE

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* In case of non-availability, the secretariat will contact you for alternate options


I hereby declare that the above mentioned information, which I have provided, is true to the best of my knowledge and can be used and shared with program stakeholders for coordination. I also give my consent for receiving communication from PHFI and publishing my feedback/testimonial which I forward to the Secretariat in any report or publication produced by PHFI. I understand that course is not a degree but only a certificate course with the objective of training doctors in prevention and management of disease area subject and successful participants are not entitled to mention/call themselves as specialist anywhere after completion of this course. I also understand that this course is not a recognized medical qualification, under Section 11(1) of the Indian Medical Council Act, 1956 & National Medical Commission Act 2019 and the institutions offering this course is neither a medical colleges nor a University nor offering this course in accordance with the provisions of the Indian Medical Act of the University Grants Commission Act.

*Decision taken by PHFI for selection and enrolment of participants will be final.