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Admission Form Step by Step

MBBS Admission Form Step-1 Basic Information
<div class="row">
<div class="col-md-6" style='margin-bottom:5px;'>
[text* your-name placeholder "Your Name *"]</div>

<div class="col-md-3" style='margin-bottom:5px;'>
[tel* st-mobile placeholder "Your Mobile No *"]</div>

<div class="col-md-3" style='margin-bottom:5px;'>
[email st-email placeholder "Your Mail Address"]</div></div>

<div class="row">
<div class="col-md-3" style='margin-bottom:5px;'>
[text* dob placeholder "Date of Birth *"]</div>

<div class="col-md-3" style='margin-bottom:5px;'>
[select* bl-group placeholder "Blood Group*" "A Positive" "B Positive" "AB Positive" "O Positive" "A Negative" "B Negative" "AB Negative" "O Negative"]</div>

<div class="col-md-3" style='margin-bottom:5px;'>
[select* gender placeholder "Gender*" "Male" "Female"]</div>

<div class="col-md-3" style='margin-bottom:5px;'>
[select* home-dist placeholder "Home District*" "Barguna" "Barisal" "Bhola" "Jhalokati" "Patuakhali" "Pirojpur" "Bandarban" "Brahmanbaria" "Chandpur" "Chittagong" "Comilla" "Cox's Bazar" "Feni" "Khagrachhari" "Lakshmipur" "Noakhali" "Rangamati" "Dhaka" "Faridpur" "Gazipur" "Gopalganj" "Kishoreganj" "Madaripur" "Manikganj" "Munshiganj" "Narayanganj" "Narsingdi" "Rajbari" "Shariatpur" "Tangail" "Bagerhat" "Chuadanga" "Jessore" "Jhenaidah" "Khulna" "Kushtia" "Magura" "Meherpur" "Narail" "Satkhira" "Jamalpur" "Mymensingh" "Netrokona" "Sherpur" "Bogra" "Joypurhat" "Naogaon" "Natore" "Chapainawabganj" "Pabna" "Rajshahi" "Sirajganj" "Dinajpur" "Gaibandha" "Kurigram" "Lalmonirhat" "Nilphamari" "Panchagarh" "Rangpur" "Thakurgaon" "Habiganj" "Moulvibazar" "Sunamganj" "Sylhet"]</div></div>

<div class="row">
<div class="col-md-3" style='margin-bottom:5px;'>
[text* father-name placeholder "Father's Name *"]</div>

<div class="col-md-3" style='margin-bottom:5px;'>
[tel* father-mobile-no placeholder "Mobile No *"]</div>

<div class="col-md-3" style='margin-bottom:5px;'>
[text* mother-name placeholder "Mother's Name *"]</div>

<div class="col-md-3" style='margin-bottom:5px;'>
[tel* mother-mobile-no placeholder "Mobile No*"]</div></div>

<div class="row">
<div class="col-md-6" style='margin-bottom:5px;'>
[text* permanent-address placeholder "Permanent Address*"]</div>

<div class="col-md-6" style='margin-bottom:5px;'>
[text* present-address placeholder "Present Address*"]</div></div>

<div class="row">
<div class="col-md-6" style='margin-bottom:5px;'>
[text local-guardian-name placeholder "Local Guardian Name"]</div>

<div class="col-md-6" style='margin-bottom:5px;'>
[tel local-guardian-mobile placeholder "Mobile No"]</div></div>

[multistep "1-3-https://emcbd.info/mbbs-application-step-2/ "]
<p>[submit "Next"]</p>


MBBS Admission Form Step-2 Academic Results

<label><center><u>MBBS ADMISSION TEST RESULT</u></center></label>

<div class="row">
<div class="col-md-2" style='margin-bottom:5px;'>
[text* roll-no placeholder "Admission Roll No*"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[text* merit-score placeholder "Merit Score*"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[text* test-score placeholder "Test Score*"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[text* merit-position placeholder "Merit Position*"]</div>

<div class="col-md-4" style='margin-bottom:5px;'>
[select* quota placeholder "Quota*" "General" "Freedom Fighter"]</div></div>

<br></br>
<p><center><u>SSC & HSC QUALIFICATION</u></center></p>
<div class="row">
<div class="col-md-2" style='margin-bottom:5px;'>
[select* ssc-exam include_blank "SSC*"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[select* ssc-pass placeholder "Passed*" "2016" "2017"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[select* ssc-board placeholder "Board*" "Dhaka" "Barisal" "Chittagong" "Comilla" "Jessore" "Mymensingh" "Rajshahi" "Sylhet" "Dinajpur" "Madrasah" "Technical"]</div>

<div class="col-md-4" style='margin-bottom:5px;'>
[text* ssc-ins placeholder "Name of Institute*"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[number* ssc-gpa placeholder "GPA*"]</div></div>

<div class="row">
<div class="col-md-2" style='margin-bottom:5px;'>
[select* hsc-exam include_blank "HSC*"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[select* hsc-pass placeholder "Passed*" "2018" "2019"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[select* hsc-board placeholder "Board*" "Dhaka" "Barisal" "Chittagong" "Comilla" "Jessore" "Mymensingh" "Rajshahi" "Sylhet" "Dinajpur" "Madrasah" "Technical"]</div>

<div class="col-md-4" style='margin-bottom:5px;'>
[text* hsc-ins placeholder "Name of Institute*"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[number* hsc-gpa placeholder "GPA*"]</div></div>

<div class="row">
<div class="col-md-2" style='margin-bottom:5px;'>
[select other-exam include_blank "Other"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[text other-pass placeholder "Passed"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[text other-board placeholder "Board"]</div>

<div class="col-md-4" style='margin-bottom:5px;'>
[text other-ins placeholder "Name of Institute"]</div>

<div class="col-md-2" style='margin-bottom:5px;'>
[number other-gpa placeholder "GPA"]</div></div>

[multistep "2-3-https://emcbd.info/mbbs-application-final-step/"]
<p>[previous "Previous"] [submit "Next"]</p>

MBBS Application Step-3 Payment & Attachments

<div class="row">
<div class="col-md-12" style='margin-bottom:10px;'>
[text* bkash-number placeholder "bKash Number *"]</div></div>

<div class="row">
<div class="col-md-12" style='margin-bottom:10px;'>
[text* bkash-amount placeholder "Amount of Taka *"]</div></div>

<div class="row">
<div class="col-md-12" style='margin-bottom:10px;'>
[text* tx-id placeholder "bKash Transaction ID *"]</div></div>
</br>
<div class="row">
<div class="col-md-6" style='margin-bottom:5px;'>
Recent Photograph: (Size 2 MB, W=200px H=200px)* [file* your-photo limit:2000000]</div></div>
</br>
<div class="row">
<div class="col-md-6" style='margin-bottom:5px;'>
Signature: (Size 2 MB, W=200px H=80px)* [file* your-signature limit:2000000]</div></div>
</br>
[checkbox* checkbox-846 "I certify that the information provided above is true to my knowledge and belief. I also understand that any false statement of information may cancel the application."]

[multistep "3-3-https://emcbd.info/thanks/"]
<p>[previous "Previous"] [submit "Final Submit"]</p>


MBBS Application Step-3 Payment & Attachments Mail Tab

<!DOCTYPE html>
<html>
<body>
<center><strong>Office of the Principal<br/>Enam Medical College<br/>Savar, Dhaka<strong><br/><br/><u>ONLINE MBBS ADMISSION APPLICATION FORM</u></strong></center>
<br></br>
<table border="0">
<tr>
<td>Application Date:</td>
<td>..........................</td>
<td></td>
<td></td>
<td>Money Receipt No:</td>
<td>..........................</td>
</tr>
</table>

<br></br>
<strong><u>Student Information:</strong></u>
<table border="0">
<tr>
<td>Name</td>
<td>: [your-name]</td>
<td></td>
<td>Mobile No</td>
<td>: [st-mobile]</td>
<td>E-Mail</td>
<td>: [st-email]</td>
</tr>
<tr>
<td>Father's Name</td>
<td>: [father-name]</td>
<td></td>
<td>Mobile No</td>
<td>: [father-mobile-no]</td>
</tr>
<tr>
</tr>
<td>Mother's Name</td>
<td>: [mother-name]</td>
<td></td>
<td>Mobile No</td>
<td>: [mother-mobile-no]</td>
</tr>
<tr>
<td>Permanent Address</td>
<td colspan="4">: [permanent-address]</td>
</tr>
<tr>
<td>Present Address</td>
<td colspan="4">: [present-address]</td>
</tr>
<tr>
<td>Home District</td>
<td>: [home-dist]</td>
<td></td>
<td>Date of Birth</td>
<td>: [dob]</td>
</tr>
<tr>
<td>Blood Group</td>
<td>: [bl-group]</td>
<td></td>
<td>Gender</td>
<td>: [gender]</td>
</tr>
</table>
<br></br>

<table border="0">
<tr>
<td colspan="2"><strong><u>MBBS Admission Test Exam Information</strong></u></td>
</tr>
<tr>
<td>MBBS Exam Roll No</td>
<td>: [roll-no]</td>
</tr>
<tr>
<td>Test Score</td>
<td>: [test-score]</td>
</tr>
<tr>
<td>Merit Score</td>
<td>: [merit-score]</td>
</tr>
<tr>
<td>Merit Position</td>
<td>: [merit-position]</td>
</tr>
<tr>
<td>Quota</td>
<td>: [quota]</td>
</tr>
</table>
<br></br>
<table border="0">
<tr>
<td>Local Guardian Name</td>
<td>: [local-guardian-name]</td>
</tr>
<tr>
<td> Mobile No</td>
<td>: [local-guardian-mobile]</td>
</tr>
</table>
<br/>
<table border="1">
<tr>
<th colspan="6"><strong><u>Academic Records:</u></strong></th>
</tr>
<tr>
<th>Name of Exam</th>
<th>Passed</th>
<th>Board</th>
<th>Name of Institute</th>
<th>GPA</th>
<th>Total GPA</th>
</tr>

<tr>
<td>[ssc-exam]</td>
<td>[ssc-pass]</td>
<td>[ssc-board]</td>
<td>[ssc-ins]</td>
<td>[ssc-gpa]</td>
</tr>
<tr>
<td>[hsc-exam]</td>
<td>[hsc-pass]</td>
<td>[hsc-board]</td>
<td>[hsc-ins]</td>
<td>[hsc-gpa]</td>
</tr>
</tr>
<tr>
<td>[other-exam]</td>
<td>[other-pass]</td>
<td>[other-board]</td>
<td>[other-ins]</td>
<td>[other-gpa]</td>
</tr>
</table>
</body>
</html>
[checkbox-846]
<br></br>
<br></br>
<br></br>
<strong><u>Payment Option</u></strong><br>
bKash Number: [bkash-number]<br>
Amount: [bkash-amount] Taka<br>
Transaction ID: [tx-id]


File Attachments Tab:
[your-photo][your-signature]

Tick the Use HTML content type

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