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* —MaleFemaleOthers Whether SC / ST / OBC / OTHERS (Select the Relevant)* —SCSTOBCOTHERS Nationality* —IndianOthers If Other, Select Country* —ArubaAfghanistanAngolaAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBotswanaCentral African RepublicCanadaSwitzerlandChileChinaCôte d’IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaSpainEstoniaEthiopiaFinlandFijiFranceMicronesia, Federated States ofGabonUnited KingdomGeorgiaGhanaGuineaGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGuatemalaGuamGuyanaHong KongHondurasCroatiaHaitiHungaryIndonesiaIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People’s Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaMozambiqueMauritaniaMauritiusMalawiMalaysiaNamibiaNigerNigeriaNicaraguaNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People’s Republic ofPortugalParaguayPalestine, State ofQatarRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSerbiaSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSeychellesSyrian Arab RepublicChadTogoThailandTajikistanTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUruguayUnited StatesUzbekistanSaint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, U.S.Viet NamVanuatuSamoaYemenSouth AfricaZambiaZimbabwe 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* —DIPLOMA IN BHARATANTYAMDIPLOMA IN CARNATIC MUSICDIPLOMA IN VISUAL ARTS Choose the main Subject* —Bharatnatyam Choose the Allied Subject* —Vocal Choose the main Subject* —VocalViolinVeenaMridangamFlute Choose the Allied Subject* —ViolinVeenaMridangam Choose the Allied Subject* —Vocal Choose the Main Subject* —Visual Arts 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* —YesNo Blood Group* Weight in kilograms* Height in Centimetres* Do you wear glasses or contact lenses?* —YesNo If yes, provide details.* Are you presently under medical care for a physical or mental health problem?* —YesNo 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?* —YesNo Have you ever been hospitalized for a mental health concern?* —YesNo Have you ever had a period of depression, anxiety or irritable mood?* for most of the day, lasting for weeks? —YesNo Have you ever been unable to do your academic work because of stress, anxiety or depression?* —YesNo Have you ever been so upset that you have harmed yourself, or been afraid that you might harm yourself?* —YesNo 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?* —YesNo 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? * —YesNo Furnish a recent of report for a chest X-ray taking upon or after the positive result:* Have you ever received tuberculosis therapy?* —YesNo Please provide information about the period for which therapy was undertaken:* Do you exhibit cough, fever, chills, night sweats, or weigh loss?* —YesNo Please provide complete details.* Date : Kind Attention to the Applicants Fill out the application in capital letters only. Make sure to verify the email address, Phone number and other details which submitted are correct. ×