AMALA INSTITUTE OF MEDICAL SCIENCES

Amala Nagar P.O, Thrissur - 680555; Ph.No. 0487 2304106

Application Form for Paramedical Courses (DMLT & DRRT)

(Courses approved by Directorate of Medical Education & Govt. of Kerala)

Application Form

Course for which admission is sought (In the order of preference)

Course Preference (1, 2)
DMLT
DRRT

Seat applied for :


If Management,

1. Name of applicant (Block letters as in SSLC)

Name of Parent/Guardian (with relationship)

Date of Birth (DOB)

Gender

Marital Status

Physically Handicapped

Religion & Caste

Permanent Address

Present Address (Address for Communication)

Email Address

Contact No (with STD)

Parent's/Guardian's Mobile No

Father's Name & Occupation

Mothers's Name & Occupation

Annual Family Income

Name of Institution last attended

Educational Qualification:

Course Name of Institution Name of Board Registration No Year of passing % of Marks
SSLC
Plus 2
Others

Plus 2 Marks

Subject Marks Obtained Max Marks % of Marks
Physics
Chemistry
Biology
English
Passport size photo
Mark List
SSLC Cert
Cource & Conduct Certificate
Transfer Certificate

Letter from Parish Priest if Christian or Syro Malabar

Date of Payment Amount (Rs.)

Declaration by the Applicant