Certificate Course in Mental Health Counselling Form

Please provide complete and correct information. All fields are mandatory. Please do not use short forms/ abbreviations.

Important Note : For PPSU Students the Registration Fee is Rs. 1500 and for Non-PPSU Students the Registration Fee is Rs. 2500.

Which University*
Student Name (CAPITAL LETTER)*
Email*
Age*
Gender*
Highest Qualification*
Current Occupation*
Full Residential address of applicant*
Contact No.(What's up No.)*
Name of Organization*
Photograph of participant* (35 mm x 35 mm size; 300 dpi resolution quality)
Adhar Card Upload(Front/Back)* Front Side Back Side
Highest Qualification Certificate/Degree*