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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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