Full Time Diploma Admission form – RDCFA

Application Form for the academic year (2023-2024)

Candidate Information

Name of the Candidate (As per the Xth Marksheet)*

Date of Birth (As per the Xth Marksheet) *

Age* (The Maximum age is 25 years as on 01-07-2023)

Student’s Photo* Max. 1MB (Only JPG/JPEG/PNG)

E-mail (Primary E-mail)*

Candidate Mobile Number *

Gender*

Whether SC / ST / OBC / OTHERS (Select the Relevant)*

Nationality*

If Other, Select Country*

Passport Number*

Upload the copy of the passport(JPG / JPEG)*

Performance Youtube URL*

“Applicants should make a sum of Rs. 500/- (its equivalent) to the following bank account. The receipt for the payment should be attached in the given column.

A/c : 443596869

“Name of the bank: Indian Bank

IFSC : IDIB000T044

Swift Code: IDIBINBBTSY

Thiruvanmiyur branch

Receipt of the payment Max. 1MB (Only JPG/JPEG/PNG)

Residential Address (Permanent)*

Choose the course of Study*

Choose the main Subject*

Choose the Allied Subject*

Choose the main Subject*

Choose the Allied Subject*

Choose the Main Subject*

Parents/Guardian Information

Name of Father / Guardian*

Father’s E-mail Address*

Father’s Mobile Number*

Passport Number

Mother Tongue*

Name of the Mother*

Mother’s E-mail Address*

Mother’s Mobile Number*

Academic Qualifications *

Education	Name & Address of Institution	% Marks	Month & Year of Passing
10th std.*
12th std.
Degree / Diploma

Attach the Marksheets: – Max. 1MB (JPEG/JPG) *

10th Std:*

12th Std:

Degree / Diploma:

Whether Hostel Accommodation Needed*

Blood Group*

Weight in kilograms*

Height in Centimetres*

Do you wear glasses or contact lenses?*

If yes, provide details.*

Are you presently under medical care for a physical or mental health problem?*

Describe the problem and treatment.*

List of medicines that you are taking (include those prescribed by a health professional as well as any other counter medications, vitamins and / or herbal supplements). Include name and dosage*

History of serious illness or injuries (include dates)*

History of surgery or hospitalizations (include dates)*

Have you ever been cared for by a mental health clinician?*

Have you ever been hospitalized for a mental health concern?*

Have you ever had a period of depression, anxiety or irritable mood?*
for most of the day, lasting for weeks?

Have you ever been unable to do your academic work because of stress, anxiety or depression?*

Have you ever been so upset that you have harmed yourself, or been afraid that you might harm yourself?*

List any allergy to medications and describe the reaction on you:*

List any food or environmental allergy and describe the reaction on you:*

Are you presently taking any injection for allergy?*

Do you plan to continue those injections while attending the College? If yes, Give details.*

Have you ever had tuberculosis or had a positive tuberculosis test? *

Furnish a recent of report for a chest X-ray taking upon or after the positive result:*

Have you ever received tuberculosis therapy?*

Please provide information about the period for which therapy was undertaken:*

Do you exhibit cough, fever, chills, night sweats, or weigh loss?*

Please provide complete details.*

Date :

Application Form for the academic year (2023-2024)

Recent Posts

Recent Comments

Archives

Categories