MASTER OF PUBLIC HEALTH

2020 - 2022 (To be filled in by the nominee / applicant in capital letters)

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Name and Surname*

Gender*

Male

Female

Age*

Date of Birth*

Nationality*

ACADEMIC BACKGROUND

Level of Academic qualification	Degree	Subject / Stream	Board / University	College / Institution of Affilliation	Year of passing	Final percentage Grade / Class
Class X	N/A
Class XII	N/A
Bachelors/Under-graduate degree*
Masters/Post-graduate degree or any other equivalent qualification
Any additional Qualification / Training

PG ENTRANCE

Have you given PG Entrance exam?

Yes

If answered yes to previous question

Full name of entrance exam

Year of appearance in exam

State (if specific to any state)

Score (percentage / percentile)

WORK EXPERIENCE (Internship not be counted in experience)

Total work experience in years

Duration of Employment	Name of Organization	Designation	Roles / Responsibilities
Current
Past

LIST OF RECENT ACADEMIC AWARDS / ACHIEVEMENTS

(Internship not be counted in experience)

EXTRA CURRICULAR ACTIVITIES

Do you belong to SC/ST/OBC/PH?

Yes

(If Yes, Please specify category please attach self-attested copy of certificate)

ENCLOSURES: (Please do not send any original certificates, they are to be produced only at the time of personal interview)

Application fee of Rs.500/- (US$8 for internation and SAARC candidates) drawn on Indian Institute of Public Health Gandhinagar to be paid along with the application form. (Send yourt payment Ref. No & Receipt No. on admission@iiphg.org)
Necessary copies of all academic statements from Class X onwards and PG entrance exam results.
Copy of resume / curriculum viteae
Contact details of 3 referees: two academic + one professional (if some work experience)
Statement of purpose (This needs to be a 250-500 words summary, written completely by the candidate, stating professional goals and career plans, including plans and expectations in pursuing MHA/MPH Programme).

Payment options: (A/C Holder Name: Indian Institute of Public Health Gandhinagar; Bank Name: HDFC, Bank Ltd.;
Branch Name: Infocity, Gandhinagar, Gujarat, INDIA, A/C No.: 50100157403005, IFSC Code: HDFC0002497, BIC/Swift Code: HDFCINBBXXX, demand draft / cheque payable at par at Ahmedabad.

(THE LAST DATE FOR THE ACCEPTING APPLICATIONS IS 31st May 2020)

Source of information about MHA/MPH Course in IIPHG*

APPLICANTS ADDRESS FOR COMMUNICATION*

CITY*

COUNTRY*

PINCODE*

PHONE (Resi.)

FAX

Mobile Number

EMAIL*

DATE

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Necessary copies of all academic statements from class X onwards and PG entrance exam results*
Copy of resume/ curriculum vitae*
Contact details of three referees: two academic + one professional (if some work experience)*
Statement of purpose (This needs to be a 250-500 word summary, written completely by the candidate, stating professional goals and career plans, including plans and expectations in pursuing MHA/MPH Programme)*

Payment Reference No/Application Fee Receipt No*

Required documents should be posted to:

Assistant Manager (Academic Programmes) INDIAN INSTITUTE OF PUBLIC HEALTH GANDHINAGAR University established under IIPHG Act 2015 of Gujarat State Opposite Air Force Head Quarters, Near Lekawada Bus Stop, Gandhinagar-Chiloda Road, Lekawada, CRPF. P.O. Gandhinagar - 382042, Gujarat, INDIA

Phone: +91-63588-40700; E-mail: admission@iiphg.org

URL: www.iiphg.edu.in, www.phfi.org

Interested in discussing?

MASTER OF PUBLIC HEALTH

MASTER OF PUBLIC HEALTH

ACADEMIC BACKGROUND

PG ENTRANCE

WORK EXPERIENCE (Internship not be counted in experience)

LIST OF RECENT ACADEMIC AWARDS / ACHIEVEMENTS

EXTRA CURRICULAR ACTIVITIES

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