Application for XIs - BS Mootha Girls Senior Secondary School

Shri B.S. Mootha Girls Senior Secondary School
Recent
Photo
(Affiliated to the Central Board of Secondary Education, New Delhi)
(Vide CBSE / AFF / 1930041 - TN.: 06942)
(Managed by Shri Rajasthani Jain Samaj Educational Trust, Chennai-600 017)
80, Brindavan Street, West Mambalam, Chennai - 600 033.
Phone : 2481 2044, 2372 4911
APPLICATION FOR ADMISSION – XI
Registration No
:
Application No. :
Class to which admission
is sought
:
Admission No. :
SSM
1.
Full Name of the Student
: ...........................................................................................................................................................
according to the Mark Sheet/TC
2.
Date of Birth : (a) In Figures
: ...........................................................................................................................................................
(b) In Words
3.
: ...........................................................................................................................................................
(Photo Copy of the Birth Certificate must be enclosed)
(a)
Nationality : ............................................................ (b) State to which student belongs : ..............................................................
(c)
ST /SC / OBC / MBC / BC / FC / Jain : .................................................................. Cast / Surname : ...............................................
(Community Certificate attested by a Gazetted Officer to be enclosed for SC / ST / OBC / MBC / BC)
Endorsement by Sec./Correspondent
(d)
4.
Mother Tongue
: .................................................................................. Blood Group : ...................................................
Bio-Data of Parents
Father
Particulars
Mother
(a) Name
(b) Educational Qualification
(d) Annual Income
(e) Address :
Res :
Off :
(f) Phone No. :
Res :
Off :
Mobile :
5.
Name & Address of Local Guardian (if any) ...........................................................................................................................................
....................................................................................................... Phone ...........................................................................................
6.
(a)
Name of school last attended : .....................................................................................................................................................
Town : ...................................................... District : ..................................................... State : .....................................................
(b)
Affiliation / Recognition / Approval No. .............................................................................................. of the School last attended.
7.
8.
Courses Offered (Note 5 elective offered)
Group I
Group II
English
English
Maths
Business Studies
Physics
Accountancy
Chemistry
Economics
Biology/Computer Science
Maths / Computer Science / Entrepreneurship
Details of Board / Examination / Marks
Name of the Board – CBSE / State Board / Matriculation / ICSE :
Roll No.: ...................................................................................
Year of Passing : ...........................................................................
TC No. & Date : ...........................................................................
Marks obtained in Std. X
English
Exam
Language
Maths
Science
Social Science
Any Other
Remarks
Note : Admission will be confirmed only on production of Original TC duly endorsed by the concerned educational authority
DECLARATION BY THE PARENT
1.
(a)
I hereby declare that the date of birth of my daughter .............................................................................................
furnished by me in Column No. 2 is correct and that I will not demand any change in it at a later date.
(b)
Transfer Certificate – Original / Photo copy to be submitted.
(c)
I have enclosed the Photo copies of the following Certificates :
(d)
1.
Birth Certificate
(
)
2.
Community certificate
(
)
3.
Report Card of Std. 10th
(
)
4.
Transfer Certificate
(
)
5.
Conduct Certificate
(
)
6.
Board Marksheet
(
)
I shall abide by the rules and regulations of the school.
Date : ............................................
2.
Signature of the Parent / Guardian
We also assure that other information given in this application are true & correct. We have read the rules and regulations of the
school and agree to strictly adhere to them.
Signature of the Student
Signature of the Father / Mother / Guardian
Signature of the Father / Mother / Guardian
Date : ............................................
Note: 1. The Management reserves the right to decline / cancel admission to any candidate without assigning any reason.
2. Registration of the candidate’s name is NOT a guarantee for admission.
For Office use only
Admit to class : XI / XII Group: I / II / Elective .....................................................................
Date :
PRINCIPAL
Name : .................................................................................................................. Admitted to Class.........................................................
Admission No. : ..................................................................................................... Date :............................................................................
Name entered in the Admission Register Book No. : ........................................................................ Page No.: ........................................
ASSISTANT IN-CHARGE
CO-ORDINATOR
Admission is subject to availability of seats and fulfillment all the criteria.