Online Application Form

Application for Admission To 2024- 2025

Diploma Courses Afiliated To The Directorate of Medical Education(DME),Kerala Govt.

Course applied for *
(Each application shall be used for one course only)

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Admission Quota*

Name of the College*

Personal Details

Name in Block Letters*

Sex*

Male

Female

Other

Date of Birth*

Age as on 1st August 2024*

Name of Father*

Name of Mother*

Religion & Community*

Permanent Address*

Address for Communication*

Phone Number*

WhatsApp Mobile No*

Email Address *

Annual Income of the Family

Details of Plus Two Examination Passed

Name of School from which presented for Plus Two Exam*

Class*

Name of the Board*

No. of chances taken for the qualifying exam.*

Marks Obtained

Subject	Marks (Biology,Physics & Chemistry)
	Maximum Marks	Marks Secured
Biology
Physics
Chemistry

*Please note that,the ranklist is prepared based on the total marks of Science Subjects.

Application Fee Details

Transaction ID.*

Date

Account Holder*

Payment Details
A/c No: 024804176659190022
A/c Name: Pushpagiri College of Allied Health Sciences
Bank Name: The Catholic Syrian Bank Ltd.
IFSC: CSBK0000248
Branch: Tiruvalla – R S Road (248) Address: Chilanka Junction Kerala - 689101

I do hereby declare that the particulars given in the application are true to the best of my knowledge and belief. If any of the particulars given by me in this application is proved fraudulent at any later stage of admission, I shall be liable for disciplinary action and my admission shall become null and void. I shall produce the originals of the certificates at the time of interview.I carefully read the prospectus thoroughly and I am ready to abide the terms and conditions mentioned in the Prospectus.

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Signature of the Candidate