St. Gregorios Dental College

Chelad (PO), Ernakulam (Dist.), Kerala, Pin: 686 681
Phone: 0485-2572529, 530, 531 | e-mail: sgdc@rediffmail.com

Application for Admission to the BDS / MDS Course 2026-27

Please fill in the details below. Fields marked * are required. Write names in block letters where indicated.

Course

Applying for *

Speciality *

Applicant particulars

1. Name of the Applicant (in block letters) *

2. Name of Parent or Guardian *

Passport size photograph JPG/PNG, max 2 MB

3. Address

(a) Permanent Address (in block letters)

PIN *

Phone No. with STD/ISD Code

(b) Address for Communication (in block letters)

Same as permanent address

PIN *

Phone No. with STD/ISD Code

Mobile Phone *

E-mail *

Personal details

Gender *

Blood Group

Whether Keralite *

Age *

Date of Birth *

Religion

Caste / Denomination

Candidate Category *

Allotted Category

Specify other reservation

Whether NRI *

Hostel facility required *

NRI additional particulars

Passport No.

Sponsor name

Country of residence

Entrance details

NEET Rank

NEET Score

CEE Application No.

State Rank

Details of qualifying examination (Plus Two)

Name of exam with University / Board

No. of attempts

Name of the Institution with State

Optional subjects / marks

Subject	Marks Secured	Maximum Marks	Percentage



Total

Details of qualifying examination (BDS)

College where BDS was studied

University

Dental Council Registration No.

Name of the State Council

Internship institution

Internship from

Internship to

Marks obtained in BDS examination

Year	Marks secured	Maximum marks	Percentage	Year of passing	Registration number
I Year BDS
II Year BDS
III Year BDS
IV Year BDS
Final BDS Part II
Total

Parent / Guardian

Name & Address of the Parent / Guardian *

Phone No.

Mobile Phone

E-mail

Relationship

Occupation

Annual Income

Declarations

I hereby declare that I have carefully gone through the prospectus and I promise to abide by the rules and regulations mentioned therein and that I am eligible to apply for admission. I further declare that I have no physical or mental disabilities that disqualify me for admission. The statements made by me in this application and the documents produced in support thereof are true to the best of my knowledge and belief.

Applicant name *

Place *

Date *

I have carefully gone through the prospectus and I undertake to pay regularly all the fees and other dues till the completion of the course. I shall be fully responsible for his/her character and conduct. I also agree that the college authorities have the freedom to expel my ward from the rolls if the management feels that his/her behaviour is against the interests of the institution.

Parent / Guardian name *

Place *

Date *