S.S.L.CMarks............................................................ & Percentage .......................
P.D.C. Marks ......................................................... .. & Percentage ......................
Degree Marks............................................................ & Percentage ......................

Merit Marks.......................................................................... ..

For Office Use only
Class No .....................................................................
Admission No..............................................................
Date of Admission.......................................................

1

Name in full ........ ....: in English
(as in SSLC Book)

...

..

: in Malayalam

...

..

Expansion of initials

...

2

Sex of the applicant

Male / Female

3

Date of Birth .......: in figures

...

..

.........................: in words

...

..

Age as on 1st October of the year of admission

...

4

Place of birth

Village:
Dist:
Taluk:
State:

5

Religion & Community

If Catholic..
........................................
Parish:
Diocese:

6

Caste and sub-caste
(strike-out whichever is not necessary)

S.C. / S.T. / O.E.C. / O.B.C
Name of caste:

Name of sub-caste:

7

Home address of the student in Malayalam

8

Name of the father:
Name of the Mother:
Occupation:
Annual Income:

Home Address

Pin Code:
Phone:

9

Office address of the parent (if employed):

Pin Code:
Phone:

10

Residence (if admitted)

at Home / College Hostel / with Guardian

11

Name and address of the local guardian
(if residing with local guardian)

...

12

Relationship of the applicant to the guardian

....

13

Whether approved records submitted in:
If in Sports / Games, specify the items
(Copies of certificate arre to be attached)

Sports /Games / N.C.C / N.S.S. / I.E.P.

14

Are you dependant of Ex-Service man /Jawan
(copies of certificates are to be attached.)

Ex-Service man / Jawan

15

Nature of Course last attended

Regular / Private study

16

Institution last attended

..

17

Conduct and character as entered in the conduct certificate from the institution last attended

........

18

No. of appearances in the qualifying examination

........

19

..Name and relation of one or two of your direct relatives who are / were students of this college:

..

Name

Course & Period of study

Your relation

1.

2.

20.

Details of the Examination ** Passed

Name of the Exam.............................................................
University / Board ............................................................

Reg. No.
Year:...
Month:

** Any applicant from a Board outside Kerala will have to attach attested copies of the mark sheet to enter proportionate marks in the above columns and to calculate merit marks accordingly.

B.Sc chemistry / Physics with not less than 55% marks in the concerned optional subject including subsidiaries can apply.

.DECLARATION

All the entries furnished in the application are correct to the best of my knowledge and I understand that incorrect and incomplete entries will forfeit my admission.

.................................................................................................Signature of the applicant ..................................................

Date ....................... .................................................................Name of the applicant.........................................................

GUARANTEE OF THE PARENT / GUARDIAN
(to be signed at the time of admission)

I ............................................................. undertake topay all fees and dues on behalf of (student's name) ....................................... who is my son / daughter / ......................................... Further I hold myself responsible for his / her conduct and good behaviour in the college.

................................................................................................Signature of the Guardian .................................................

Date ............................. .........................................................Name of theGuradian..........................................................

FOR OFFICE USE ONLY

Approved for admission to ......................................................................

..Date.......................... ......................................................................................................................PRINCIPAL