1. Name of the Course *
B Optom

2. Year of Admission *

3. Name of the Candidate in BLOCK LETTERS (As entered in the Higher Secondary certificate ) *

4. Expansion of Initials *

5 Sex *
MaleFemaleOther

6. Date of Birth (Christian Era) *

(The candidate should have completed 17 Years of age at the time of admission or should complete the age on or before 31st December of the year of admission)

9. Native Place

10. Permanent Residential Address *

11. Present Address *

12. Email id *

15. Religion *

16. Community *

17. Date of joining the course

18. Qualification and marks obtained

(a) Examination passed *

(b) Name of the Board (State/Central/Others) *

(c) School / College *

(d) Duration Of the Course *

(e) Register No. *

(f) Month/ Year of Passing *

19. Marks Obtained in Subjects

Fill any one Of them

20. FOR CANDIDATES WHO HAVE PASSED THE QUALIFYING EXAMINATION OTHER THAN H.S.C. OF TAMILNADU

(a) Whether Eligibility Certificate obtained from The T. N Dr. M.G.R. Medical University is enclosed

(b) Whether Transfer Certificate is enclosed

(c) Migration Certificate

21. FOR CANDIDATES WHO HAVE PASSED THE QUALIFYING EXAMINATION ABROAD

(a) Whether Eligibility Certificate obtained from the T.N. Dr. M.G.R. Medical University is enclosed

(b) Whether passport and “Student Visa” have been obtained (Xerox Copies should be enclosed)

22. Blood Group
A+A-B+B-O+O-AB+AB-

23. Blood Group Certificate from a competent person should be enclosed

24. Date Of Birth Evidence should be enclosed

25. State whether SC/ST/MBC/DC/BC/others (Original community certificate should be enclosed)

26. Willingness to donate blood
YesNo

27. Photograph (Preferably white background) *

28. Upload Qualifying Exam Mark Sheet like +2 or CBSE or ICSE etc