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RAJAGIRI HIGHER SECONDARY SCHOOL |
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Rajagiri,Kalamassery- 683 104, Phone :
0484-4111401 |
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APPLICATION FOR ADMISSION
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TO THE HIGHER SECONDARY COURSE
(Classes 11 & 12) |
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(Fields marked with *
are mandatory)
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| 1. |
Name of applicant(IN BLOCK
LETTERS)* |
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| 2. |
Year(s) of the Course |
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| 3. |
Gender*
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| 4. |
Age & Date of birth* |
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| 5. |
Place of Birth(with Dist. &
State)* |
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| 6. |
Place of Residence |
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| 7. |
Name (IN BLOCK LETTERS) & Ocupation
of Father/Mother/Guardian* |
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| 8. |
Permanent Home Address of the
Parent/Guardian with Pincode* |
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| 9. |
Address to which communications are to be sent with Pincode
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| 10. |
Religion and Caste |
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| 11. |
(a) Contact Phone No. with STD Code* |
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| 12. |
Mobile* |
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| 13. |
Email
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| 14. |
Whether belongs to (tick the
relevant column)* |
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| 15. |
Whether the applicant is(tick the relevant column) |
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| 16. |
Are You Eligible for bonus
score(tick the relevant column) |
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| 17. |
Are You Eligible for reservation under Sports Quota :
Sports and Games Winner. |
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| 18. |
Prizes won in |
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| 19. |
Details of participation in co-curricular activities (Red Cross,Social Service
Club,Science Club,Environment Club,Forestry Club,Philately Club,Debating
Club,Oratory Club etc.)
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| 20. |
Whether the applicant is eligible for
educational concessions from Government |
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if Yes ,furnish details |
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| 21 |
Name and address of the school
in which the applicant studied for the S.S.L.C or equivalent examination |
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| 22. |
Courses study in class 10* |
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| 23. |
a) No.of chances taken for
passing the SSLC or equivalent examination |
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b)Reg . No,Month & year of
appearance |
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| 24. |
Number and date of T.C issued from the
institution last studied |
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| 25. |
Group and Subjects
Combination(tick the relevant group) *
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| 26. |
Second Language chosen under
Part II (tick the relevant column)* |
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| 27. |
DD No* |
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| 28. |
DD Date* |
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| 29. |
Bank Name* |
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| 30. |
Grade/Marks of Qualifying Examination(Self attested
Photostat copies of the SSLC/Equivalent Examination to be enclosed)* |
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