1 Program & Stream 2 Personal Info 3 Contact & Address 4 Academic Qualifications 5 Professional / Experience 6 Stream-Specific Questions 7 PRISM Pathway & Future Plans 8 Declarations & Submit Step 1 of 8 — Program & Stream 1. Program & Stream Selection Application Type: New Enrollment Upgrade (Basic → Advanced) Re-enrollment / Deferral Certification Track Applying For: Basic I-PRISM Advanced I-PRISM Both Primary Stream (mandatory): -- Select Stream -- Medical Stream Pharmacy Stream AYUSH Stream CAM & International Practitioners Stream Engineering Stream Life Sciences Stream Sub-Stream / Background: -- Select Sub-Stream -- Mode of Study: Online Hybrid On-campus (when available) Preferred Training Centre: -- Select -- Hyderabad Other Preferred Intake - Month Preferred Intake - Year Schedule Preference: Weekday Evenings Weekends Flexible Time Zone (for international applicants): 2. Personal Information First Name: Middle Name: Last Name: Date of Birth: Gender: Male Female Non-binary / Other Prefer not to say Nationality: ID (last 4 digits – Aadhaar / PAN / Passport): 3. Contact & Address Primary Email: Mobile Number (with country code): Alternate / WhatsApp Number: Address Line 1: Address Line 2: City: State / Province: Postal / ZIP Code: Country: Emergency Contact Name: Relationship: Phone: 4. Academic Qualifications Highest Completed Qualification: University / Board: Country: Year of Completion: Percentage / CGPA (if applicable): Additional Degrees / Diplomas (if any): 5. Professional Registration & Experience (Fill what applies to your stream; others can skip.) Professional Council / Licensing Body (if applicable): Registration Number (if applicable): Year of Registration: Current Role / Designation: Current Organization / Institution: Years of Experience: 0–1 1–3 3–5 5–10 >10 6. Stream-Specific Questions Fields below will be relevant based on your selected stream. Medical Stream Details Primary Specialty (for MD/DO, if applicable): Top 3 clinical areas where you see high unmet need / frustration: What do you hope to achieve with PRISM in your practice? Better outcomes in chronic & geriatric patients Reduction in polypharmacy & ADRs Research & publication in integrative medicine Start or lead an integrative PRISM clinic Prepare for international opportunities Other Pharmacy Stream Details Primary interest area: Formulation / R&D Clinical Pharmacy / Pharm.D practice Regulatory / QA / QC Academics / Teaching Entrepreneurship (nutraceuticals / herbal products) What excites you about PRISM? Dosha-based pharmacogenomics Integrative herbal–drug formulations Pharmacovigilance in integrative settings Multi-omics and AI-driven drug modeling AYUSH Stream Details System: Ayurveda Homeopathy Unani Siddha BNYS Clinical strengths you already have: Panchakarma / Detox Classical herbal formulations Yoga therapy Chronic disease management Mental health / psychosomatic Aspirations with PRISM: Scientific validation of my system Integrating with allopathy in hospitals Leading translational AYUSH research Running a high-end integrative franchise clinic Teaching / curriculum development CAM & International Practitioners Primary modality: Country / Region of Practice: License / Registration Body (if applicable): Goals with PRISM: Add Ayurveda / Yoga layer to my practice Cross-cultural integrative research Develop global integrative protocols Build an international PRISM-linked centre Engineering Stream Details Technical focus: AI / ML / Data Science Embedded / IoT / Devices Robotics / Mechatronics Software Engineering / Full stack Interest areas in PRISM: AI for diagnostics Medical devices / sensors Robotics for rehab / therapy Health data platforms / telemedicine Life Sciences Stream Details Specialization: Career focus: Research / PhD Industry R&D Clinical / translational research Teaching / academia With PRISM, I want to: Work in multi-omics / ayurgenomics Design experiments for integrative medicine Join PRISM R&D / lab teams Develop products / formulations 7. PRISM Pathway & Future Plans Intended Pathways (tick all that apply): Clinical practice enhancement Research & Publications Doctoral / PhD aspirations Franchise / entrepreneurship Healthtech / AI & device innovation Academics and teaching Policy / systems-level work Would you like to be considered later for: 3-year PRISM PG / MD–PhD style program Dedicated research fellowship Franchise partner programme 8. Declarations & Consent Academic & Professional Declaration I hereby declare that all the information provided in this form and in the attached documents is true, correct, and complete to the best of my knowledge. I understand that any misrepresentation or suppression of facts may lead to rejection of my application or cancellation of enrollment without refund. I Agree Professional Eligibility I confirm that I am legally authorized to practice in my jurisdiction where applicable and that I will not misrepresent my scope of practice while using PRISM tools or brand. I Agree Data Protection & Communication Consent I consent to the collection, storage, and processing of my personal data by I-PRISM / Sai Ganga Panakeia and its academic partners solely for academic, administrative, and legal purposes related to this program. I consent to being contacted via email, phone, and WhatsApp regarding my application, course updates, and relevant opportunities. I consent to data processing for academic administration. I consent to receive communication via Email I consent to receive communication via Phone I consent to receive communication via WhatsApp Research & Case Data (Optional) I am open to being contacted for voluntary participation in anonymized research or case documentation projects related to I-PRISM. Yes No Digital Signature (Full Name): Place: Date: Previous Save Next Submit Enrollment Application ready to submit Your form is complete. Press Submit to send your enrollment.
