Fixed Contact Form

Application Form For (*)
—Please choose an option—B.Sc Physician AssistantB.Sc Cardiac TechnologyB.Sc Radiography and Imaging TechnologyB.Sc Operation Theatre and Anesthesia TechnologyB.Sc Dialysis Technology B.Sc Respiratory TherapyDiploma In Nursing
Name of the Applicant(*)

Gender(*)
MaleFemale
Date of Birth(*)

Student Photo(*)

Parent Information (*)
ParentGuardian
Father / Guardian Name (*)
Father Occupation (*)
Parent Mobile Number (*)
Student Mobile Number (*)
Student Email ID (*)
Address for Communication (*)
Address for Communication (*)
District (*)
Postal / Zip Code (*)
Qualifying Exam (*)
Higher Secondary (+2)SSLC (10th)
Board (*)
—Please choose an option—Tamilnadu State BoardCBSE Board
Medium (*)
TamilEnglish
School Attented (*)
Exam Reg No (*)

DECLARATION OF THE CANDIDATE (*)

I declare that the particulars mentioned above are true and I will not claim/ ask for any change with regard to any of the particulars furnished above. I am aware that providing incorrect information form can result in the cancellation of my admission at any stage.I agree to abide the rules and regulations of the Institution and University as framed from time to time.

I accept the Terms and Conditions.
Signature of the candidate (*)