QREC CLINICAL RESEARCH INSTITUTE, INDIA
Registered & ISO 9001:2008 CERTIFIED QREC CLINICAL RESEARCH INSTITUTE, INDIA Authorized Learning centre of TEXILA AMERICAN UNIVERSITY ADMISSION FORM <<For Office Use only>> Application received onEnrollment number allotmentAcknowledgementBranch- Affix your Passport size photo here <<To be filled by the candidate>> NameDate of BirthGenderPermanent AddressMailing AddressContact numberEmail I.D- <<ACADEMIC DETAILS>> S.No. Qualifications Year of Passing University Division <<COURSE APPLIED FOR>> S.No. Name of the course 1. Certificate Course In Clinical Research 2. Diploma in Clinical Research & Regulatory Affairs 3. Diploma in Clinical Research & Clinical Data Management 4. Diploma in Clinical Research, Pharmacovigilance & Medical Writing 5. M. Sc. in Clinical Research (affiliated from TAU) 6. PHD in Clinical research (affiliated from TAU) QREC Clinical Research Institute Duration Tick √ Code 3 Months 6 Months 6 Months 6 Months 2 years 3 years www.qreccr.com UNDERTAKING BY APPLICANT I ________________________________ hereby declare that the above information provided by me is true to the best of my knowledge. I will maintain the decorum of the Organization and will not breach the confidentiality. I also understand that: • • • QREC reserves the right to change the rules & regulation from time to time in its sole and absolutely discretion. In case of rejection of the application only 50% of the fee is refundable. All instalments are to be paid by due date. A fine of 10$ will be charged after the due date for a maximum period of 10 days. • No fees if refundable once paid in any circumstances. • The management reserves the right to rusticate any student for any misbehaviour with staff or student or for lacking any student like qualities. No refund of the fees will be final or binding. • The institute reserve the right to recover any damage in case of loss or damage to the equipment and property of the institute. • The diploma in clinical research, medical writing & pharmacovigilance is the skill development autonomous program run by QREC Clinical Research Institute. The course content has been developed by a team of Clinical Research professionals having experience in the conduct of Global Clinical trials. • Any misuse, copy or passing of the content provided by QREC Clinical Research Institute to other non registered person is a punishable offence. Kindly take permission from the authorised person of QREC before doing so. Date Name Signature QREC Clinical Research Institute www.qreccr.com PAYMENT DETAILS 1) For Online Payment: > Bank Name: IDBI Bank, Alwar, India > Account No. : 0247102000008396 > IFSC Code: IBKL0000247 > Swift Code: IBKLINBB013 Please affix the following documents • PAN CARD/ VOTERS I.D./ PASSPORT/DRIVING LICENSE • CURRENT TWO PASSPORT SIZE PHOTOGRAPH • ADDRESS PROOF For Students: Any One of the following: • Provisional Certificate (Institution last attended) • Character Certificate (Institution last attended) • Mark sheet (Latest) • Mark sheet of class 10th & 12th class. For more details contact: QREC Clinical Research / Institute (Regd. & ISO 9001:2008 CERTIFIED) All completed applications should be sent to: Head Office – 211, Scheme No. 1, Alwar – 301001, Rajasthan, India. Phone No. – +91- 7597364480, Email: [email protected], Website: www.qreccr.com For any QUERY join with us on our Whatsapp no. - +91-8107747750 FOLLOW US: QREC Clinical Research Institute www.qreccr.com
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