Please Read the Eligibility Criteria before filling the form.

1. Registration does not ensure Admission.
2. The registration form is likely to be rejected if any discrepancy is found.
3. Registration fee is non-refundable..
4. Fee Structure will be according to government rules.

Select Course/Programme Master of Physiotherapy Bachelor of Physiotherapy Diploma in Dialysis Technician Diploma in Medical Lab Tech Certificate in O.T.Technician

Specialization In Orthopedics Neurology Year of College Passing 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013

Year of Class Passing 12^th 2023 2022 2021 2020 2019 2018 2017 2016 2015

Student Details

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-Religion - BUDDHISM CHRISTIAN HINDU JAIN MUSLIM PARSI SIKH OTHER

- Category - GEN OBC ST SC MINORITY

Father's Detail

Education GRADUATE POST-GRADUATE PROFESSIONAL OTHER

Occupation SERVICE BUSINESS SELF EMPLOYED OTHER

Mother's Detail

Education GRADUATE POST-GRADUATE PROFESSIONAL OTHER

Occupation SERVICE BUSINESS SELF EMPLOYED HOMEMAKER OTHER

Guardian's Detail : (if Applicable)

Education GRADUATE POST-GRADUATE PROFESSIONAL OTHER

Occupation SERVICE BUSINESS SELF EMPLOYED OTHER

Residential Address

Are you Alumni of Choithram Group of Institute ?

1.Father ------ Yes No ------ 1972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

2. Mother ------ Yes No ------ 1972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

3. Self ------ Yes No ------ 200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023

Declaration

I hereby confirm that all the above information is correct. I also agree that Submission of application form does not imply confirmed admission.