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APPLICATION FORM FOR ADMISSION
Academic Course Registration (Distance Education)

Course Details

Select Course

:
 Secondary Course
  Senior Secondary Course

Examination Year

:

Select Exam Time

:
 April/May Examination
  October/November Examination

Student Details

Name of Candidate

:

Father's Name

:

Mother's Name

:

Guardian Name for Orphan

:

Address

:

Email

:

Pincode

:

Contact No

:

 

 

Age

:

 

 

Gender

:

Course Applied For

:

Medium of Study

:

Mother Tongue

:

Nationality

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Religion

:

Your Previous Qualification

:

Father Education Qualification

:

Mother Education Qualification

:

Place of Residence

:

Employment

:

Annual Family Income

:

Photo

:

jpg format, 150 pixels (Width) X 200 pixels (Height)

The Examination Center Selected States

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Sub I

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Sub II

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Sub III

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Sub IV

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Sub V

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X th Bord Exam Details (Senior Secondary Course Only)

:

 

 

 

 

Registration Fee Details

 

 

 

 

 

 

 

Permanent Address

:

Pin

:

 

 

Enter Code

:

DECLARATION OF STUDENT/PARENT

I hearby declare that,I am enrolling myself for the correspondence course of distance education. I have gone through the brochure and website of this course and Ihave fully understood it. I agree and accept the terms and conditions said in the brochure and website.I also agree that it is my personal responsibility to study the course and to pass the examination

All disputes and claims will be resolved by way of Arbitration according to the Arbitration and Conciliation Act,1996 and the Jurisdiction will be in Ernakulam district. If the applicant violates any of the terms of the rules and regulations of the course he/she is likely to be terminated and no part of the fee collected would be refunded. The institution will not be liable for any failure due to act of God, act of Government or Statutory undertaking or anything beyond the institution's control nor we would be liable for any incidental or consequential loss or damage arising out of this

I accept the declaration