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APPLICANT INFORMATION

    Date Of Application:

    Select Course:

    First Name:

    Last Name:

    Gender:

    Date Of Birth:

    Nationality:

    Permanent Residence

    Address:

    Country:

    State:

    E-mail ID:

    Phone No.:

    Language Proficiency

    LANGUAGE

    SPEAKING

    WRITING

    READING

    ENGLISH

    MALAYALAM

    HINDI

    OTHER (Option to type)

    OTHER (Option to type)

    Are You Eligible For Reservation:
    YesNo

    If Yes, Please Mention Category:

    PARENT/GUARDIAN INFORMATION

    Name Of Parent/Guardian:

    Relationship To Applicant (Mother/Father/Aunt/Uncle Etc.):

    Contact Number Of Parent/Guardian:

    Email ID Of Parent/Guardian:

    Address For Correspondence:

    Country:

    State:

    Full Address:

    Permanent Address:

    Same As Address For Correspondence:
    YesNo

    Country:

    State:

    Full Address:

    Occupation:

    Annual Income:

    Highest Educational Qualification Completed:

    ACADEMIC & EXTRA CURRICULAR QUALIFICATIONS OF APPLICANT

    Fill In All Academic Qualifications Completed/Pursuing Till Date

    QUALIFICATION

    SCHOOL /COLLEGE

    BOARD /UNIVERSITY

    MONTH & YEAR OF JOINING

    MONTH & YEAR OF PASSING

    % OF MARKS / GRADE

    10TH / O LEVEL / EQUIVALENT

    12TH/A LEVEL/EQUIVALENT

    BACHELORS DEGREE

    MASTERS DEGREE

    Other:

    Other:

    Other:

    Please Share Details Of Any Awards/Honors/Other Achievements, Academic And Extra Curricular:

    Have You Been A Part Of NCC/NSS/Scouts/Guides Etc. At Your School?
    YesNo

    If Yes, Please Detail:

    SPECIAL NEEDS AND MEDICAL INFORMATION:

    Do You Currently (Or In The Past) Have Any Learning Disabilities?
    YesNo

    If Yes, Please Detail:

    Do You Have Any Special Needs As A Learner?
    YesNo

    If Yes, Please Detail:

    Do You Currently (Or In The Past) Have Any Physical Disabilities?
    YesNo

    If Yes, Please Detail:

    Are You Currently Experiencing Any Physical Ailments?
    YesNo

    If Yes, Please Detail:

    Are You Currently Experiencing Any Mental Health Ailments?
    YesNo

    If Yes, Please Detail:

    Please Share Any Medication You Are Taking For The Same:

    Have You Been Hospitalized In The Last 12 Months?
    YesNo

    If Yes, Please Detail:

    Please Share Any Medication You Are Taking For The Same:

    Do You Suffer From, Or Have You Ever Suffered From A Serious Or Life-Threatening Medical Condition?
    YesNo

    If Yes, Please Detail:

    Please Share Any Medication You Are Taking For The Same:

    ADDITIONAL INFORMATION

    Is There Currently (Or In The Past) Any Police Case Registered Against You?
    YesNo

    If Yes, Please Detail:

    Any Other Information You’d Like To Share:

    How Did You Hear About Us? :

    UPLOAD DOCUMENTS:

    Upload Certificates:

    Upload ID Proof Of Applicant (Eg. Aadhaar Card/PAN Card/Passport):

    Upload Passport Size Photo Of Applicant:

    Upload ID Proof Of Parent/Guardian (Eg. Aadhaar Card/PAN Card/Passport):

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