PRAYAGA

Confluence that influence your destiny!

FOUNDATION FOR EXCELLENCE AND TRAINING

Kunnathurmedu, Palakkad

prayagainstitution@gmail.com

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1. Name (as in SSLC Book):

2. Expansion of Initial:

3. Date of Birth (as in SSLC Book):

4. Sex:
MaleFemaleOther
5. Nationality:

6. Mother Tongue:

7. Religion and Caste:

8. Community:
SCSTOBCGENERAL
9. Address:

Land/Phone No:

Parent’s Phone No:

10. Name of Parent / Guardian:

11. Relationship:

12. Occupation of Parent or Guardian and Annual Income:

13. Whether a resident of Kerala?
YesNo
13a. Name of Taluk and District:

14. Name of Institution last studied:

14a. Qualifying Examination Passed:

Reg No:

Month:

Year:

15. SSLC Examination Passed:
Reg No:

Month:

Year:

16. Number of chances taken:

17. Have you applied for management quota?
YesNo
18. Are you eligible for NSS/NCC quota?
NSS:

NCC:

19. Have you represented in the National / State / University level?
National:

State:

University:

20. Claims (if any):

21. Claims (for ex-serviceman / dependents):

22. For candidates sponsored by institutions:

23. Place of birth:

24. Course for which admission is sought:


First Preference:

Second Preference:

Third Preference:

25. Second Language:

26. Details of marks>

DECLARATION

I declare that the particulars given above are correct to the best of my knowledge and belief.
I shall obey the rules and regulations of the college and undertake to attend classes and tests.

Place:

Date:

Signature of Applicant:

I hereby guarantee the good conduct of my ward and payment of fees. I agree to withdraw him/her in
case of misconduct or failure in studies.

Guardian’s Name:

Phone No:

Mob No:


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