Application Form

MAR THOMA COLLEGE OF SPECIAL EDUCATION BADIADKA, KASARAGOD

(Affiliated to Kerala University of Health Sciences & Recognized By Rehabilitation Council Of India)

APPLICATION FOR ADMISSION

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

Upload Your Passport Size Photo *

Name of the College*

Name in Block Letters*

Sex*

Male

Female

Date of Birth*

Place of Birth*

District *

State *

Mother Tongue*

Religion *

Cast*

Name of Father*

Name of Mother*

Nationality*

Permanent Address*

Address for Communication*

Phone Number*

Mobile No*

Email Address *

Details of Examination Passed

College/Institution where last studied *

Year*

Class Passed *

Name of University Board Issuing the Certificate*

Marks Obtained in qualifying examination

Subjects	Maximum Marks	Marks Secured	Percentage
Physics
Chemistry
Mathematics
Biology
Computer Science
Biotechnology
Total Marks

Marks Obtained in BASLP Semisters

Semester	Maximum Marks	Marks Secured	Percentage
First Semester
Second Semester
Third Semester
Fourth Semester
Fifth Semester
Sixth Semester
Total Marks

Application Fee Details

Transaction ID.*

Date

Bank*

DECLARATION BY THE CANDIDATE

I hereby declare that I have carefully read the condition for admission and that the information furnished is true. If admitted, I undertake to abide by the rules & regulations of the college and my active participation in all the curricular and co-curricular programmes.

Name & Signature of the Candidate

DECLARATION BY THE PARENT/GUARDIAN

I hereby declare that I have known the financial obligation of my ward & I undertake to pay the tution & other fees on due time as per the rules. I am aware that the fees once paid to the college for admission will not be refunded in case he/she does not join the course, discontinues the studies or is expelled from the college for any reason. I agree to pay the full fees if the candidate discontinues the course. I also stand by the declaration given to the college by my son/ daughter

Name & Signature of the PARENT/GUARDIAN