Student Registration Form

Profile Image

Applicant's Signature

Name of the Candidate

Date of Birth

Gender

Nationality

Permanent Address

Current Address (if different)

Name of Parent/Guardian

Mobile Number

Home Number

Educational Qualification

Name of Course	Name of Board/University	Year of Passing	Marks in Physics	Marks in Chemistry	Marks in Biology	Percentage/Grade Obtained

NRI:

Yes

(Centralised Allotment Process Registration No.)

Enclosures:

Copy of Certificate to prove date of birth

Attested Copies of 10th and 12th Mark Sheets

Original Transfer Certificate

Migration Certificate for other state candidates

Proof of Centralised Allotment Process Registration

Copy of Aadhar Card

Passport-sized Photographs – 5 Nos

NRI – All documents as mentioned in GO No.375/2020/H&FWD

Declaration

I hereby declare that the information provided in this application form is true and correct to the best of my knowledge. I understand that any false information may lead to disqualification from the admission process.

For any further details, please contact: The Principal, Chaithanya Institute of Optometry & Vision Sciences Chaithanya Eye Hospital Complex Kesavadasapuram, Thiruvananthapuram – 695 004 Contact Number: 9895499953 Email: info@chaithanyafoundation.org Last Date for submission of Application: 01 September 2025