ACRS Academy

Application Form for Admission

Apply for a clinical research course at ACRS. Fields marked * are required.

Course

Course applied for *

Mode of learning *

Campus

Personal information

First name *

Middle name

Last name *

Date of birth *

Email *

Mobile *

Address line 1 *

Address line 2

City *

State / province *

PIN / postal code *

Country *

Education

Your graduation, or the last exam you attempted.

Course / degree *

Institute / college *

University *

Status *

Percentage / grade *

Year of completion *

Other qualification (optional)

University and degree

Percentage / grade

Year of completion

Documents

JPG or PNG, max 1 MB each.

Passport-size photograph *

Last semester mark sheet *

Payment details

Voucher no. (if any)

Payment mode *

UTR no. / reference no. *

Transaction date *

Amount (₹) *

Direct deposit of fees

A/c name: Alchemy Clinical Research Services
A/c number: 242102000000092
Bank: Indian Overseas Bank
Branch: Pande Layout, Nagpur
IFSC: IOBA0002421

UPI QR code for paying fees to Alchemy Clinical Research Services

Prefer to apply by post?

Send the printed form with your mark sheet and a cheque or DD for the fee, made out to "Alchemy Clinical Research Services" and payable at Nagpur, to: The Registrar, Alchemy Clinical Research Services, 38, Laghuvetan Society, Near Kachore Lawn, Somalwada Road, Manish Nagar,Nagpur 440015, Maharashtra, India. You can also download the offline form (PDF).

By applying you agree to our fees and refund policy.