STUDENT APPLICATION FORM

1. Full Name*

2. Father’s / Mother’s Name*

3. Date of Birth*

4. Age*

5. Gender*
SelectFemaleMaleOther

6. Highest Qualification*

7. University / Institution*

8. Year of Passing*

9. Current Occupation

10. Full Address*

11. District & State*

12. Mobile Number*

13. WhatsApp Number*

14. Email Address*

Course Applied For*
Select a courseDiploma in Dietetics Health Nutrition & Weight ManagementDiabetic Educator CoursePG Diploma ProgramsDiploma in Nutrition & DieteticsDiploma in Clinical NutritionCertificate in Child Care NutritionCertificate in Weight Management & Slimming TherapiesCertificate in Online Nutrition & DieteticsCertificate in Sports & Fitness NutritionCertificate in Online Personality DevelopmentCertificate in Nutrition & DieteticsCertificate in Online Clinical Nutrition

15. Preferred Class Time*
SelectMorningAfternoonEveningWeekend

16. Payment Option*
Single PaymentInstalment

17. How did you hear about us?*
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Passport-size photograph*

Aadhaar Card / Photo ID*

Degree certificate or latest qualification certificate*

I confirm that the information provided above is correct. I agree to follow the academic, attendance and fee-payment rules of JV NUTRITION & ACADEMY LLP.

Student Name*

Date*