Certificate in Medical Education :: CMEd

ADMISSION FORM

All Star (*) marks field are mandatory.
Please fill-up the application form in English. br For better performance use Mozilla Firefox & Google Chrome latest version.

BASIC INFORMATION

Year

Session

Fellow Name

BMDC Registration No

Father's Name

Mother's Name

Email Address

Mobile No

National ID

Passport No

Date of birth

Blood Group

Gender

Marital status

Religion

Nationality

Facebook ID

Skype ID

Viber Account No

Contact person name

Contact person mobile no

Preferred time of Call

Proposed way of payment

Present place of work

Job Designation

Permanant Address

Division	District	Thana	Address

Mailing Address

Division	District	Thana	Address

Educational Qualification

Name Of Examination	Passing Year	Group/Batch/Session	Board	Institute Name	Result(GPA/DIVISION)

TEACHING EXPERIENCE

Institute Name	Designation	Length of Service	Action
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OTHER TRAINING PROGRAM ATTENDED

Training Name	Duration	Organization	Action
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DOCUMENTS

Each document Size: 500Kb Max and only (jpg/png/pdf) is allowed to upload

MBBS Certificate

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POST Graduate Certificate

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NID

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Applicant's Image

Photographs of Fellow
(Image Size:5mb Max, width & height(300 X 300 Pixel), only (.jpg) is allowed to upload)

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Applicant's Signature
(Signature Size:50Kb Max, width & height(300 X 80 Pixel), only (.jpg) is allowed to upload)

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Total course fee 25,000.00 Taka should be deposited at any cash counter of BIRDEM under "Certificate Course in Medical Education".

Course fee should be deposited after you are selected for the course.