Name of the Applicant *
Address (Residence) *
Phone Number with STD Code
Email * (only one application per email id)
Sex Male    Female
Date of Birth
Religion   Caste:
Reservation General SC  ST OBC
Name of the institution where the applicant is/was a student
Marks scored in the previous exam Class 10 - Syllabus : SSLC  CBSE     Marks (%)   
Class 12 - Syllabus : +2       CBSE     Marks (%)   
Phy Chem Maths Bio
Previous entrance rank if any (Repeaters only)
Father's/Guardian's Name
Occupation of Father
Occupation of Mother
Course to which admission is sought Medical  Engineering 
Preferred Centre
Payment Details (DD must be drawn in favour of Darsana Academy, payable at Kottayam) DD No. Date Amount 
Bank and Branch 

 * - mandatory fields.