SL No.

2019/________________
D.A.V. KAPILDEV PUBLIC SCHOOL
New A. G. Co-Operative Colony Kadru, Ranchi – 834002
Student
ADMISSION FORM Photograph
Class XI [Session 2019-2020]
Stream Applied for ………………………………………..

FOR OFFICE USE ONLY FOR OFFICE USE ONLY

Aggregate Admn No.___________________

English Class - XI Section - _______

Receipt No. __________________
Maths
For Admission
Gen. Science
Signature ___________________
Soc. Science

NOTE: FORM SHOULD BE FILLED IN CAPITAL LETTERS

Date of Application _____________________________________________
1. Full Name of the Student _____________________________________________
2. Date of Birth (a) In figure _____________________________________________
(b) In words _____________________________________________
3. Religion _____________________________________________
4. Do you belong to Gen/ SC/ ST/ OBC _____________________________________________
5. Nationality _____________________________________________
6. Full Name of Father _____________________________________________
7. Full Name of Mother _____________________________________________
8. Full Address of Father/ Guardian (Local)_____________________________________________
_____________________________________________
_____________________________________________
9. Year of Passing class X _____________________________________________
10. Name of Board _____________________________________________
11. Details of Marks obtained in class IX and X
Subject Max. Marks Marks Obtained % of Marks % Aggregate Medium
IX X IX X IX X IX X of Exam.
English
Hindi
Maths
General Science
Social Science
Sanskrit

Note: Photocopy of Marksheet to be Attached

12. Subject Offered
(i) ___________________________ (ii) ___________________________
(iii) ___________________________ (iv) ___________________________
(v) ___________________________ (vi) ___________________________
13. Occupation of Father _____________________________________________
14. Designation (if in Service) _____________________________________________
15. Annual Income (Rs.) _____________________________________________
16. Occupation of Mother _____________________________________________
17. Designation (if in Service) _____________________________________________
18. Annual Income (Rs.) _____________________________________________
19. Phone Number _____________________________________________
20. Mobile Number _____________________________________________
21. Permanent Address _____________________________________________
_____________________________________________
22. Mother Tongue of the Student _____________________________________________
23. Other Language Known _____________________________________________
24. If suffering from any disease (i) ___________________ (ii) Blood Group _______
25. Co-curricular Activities _____________________________________________
(Certificate attach in support) _____________________________________________
26. Name of Brother and Sister, if studying in this School with Class / Section
(i) ___________________________ (ii) ___________________________
(iii) ___________________________ (iv) ___________________________
27. Declaration
(a) I do hereby declare that all the information furnished in respect of my son / daughter / ward
_____________________________ is true in my knowledge and belief.
(b) I shall abide by all the rules and regulation of the school.
(c) If my ward commits any kind of indiscipline, he/she may be expelled / punished by the school.
(d) As per CBSE Norms he/she will at least attend 75% classes, failing which he/she may not be
allowed to the examination.
(e) I will pay the school fee in time every month (All types of fees including admission fees are not refundable)

Father’s Mother’s
Photographs
Father’s Photographs
Local
Photographs Signature of Parent / Gradian
Guardian’s Of the Student Of the Student
Photograph Of the Student

Signature of Student Signature of I/C(ADM) Signature of Principal