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Application Form

First Name
Last Name
Nationality & State
Date Of Birth
Religion & Cast
Photo(.jpeg file only)
Gender Male Female
School previously attended with period in each Name of School Standard Date of admission Date of leaving
Does the candidate belong to the Scheduled Caste or Scheduled Tribes or other backward communities or is he/she a convert from Scheduled Caste or Scheduled tribes Yes No
Standard to which to admission is sought (in words)
No. and date of Transfer Certificate
ldentification Marks
Date of Admission
List of Certificates to be attached (Birth Certificate, TC and Report Card)(.jpeg file only)


Father's / Mothrer's Details
Name of Father
Name of Mother
Teliphone No - Office
Employer/ Office Address
Local Guardian
First Name
Family Name
Teliphone No - Office
Occupation / Title
Employer/ Office Address
Name, address, occupation and relationship of the local guardian in case the pupil does not live with his/ her resPonsible guardian
Area of Residence
REQUESTal Address
Pin Code
Email Address
Phone No


Blood Group
Allergy Asthma
Diabetes Epilepsy
Urinary Disorder Hearing Problem
Heart Disorder Skin Problems
Other Medical Problem Is Your child taking any Medication?
Has your child had chickenpox? Has your child had measles?
Does your child have a positive family history of Diabetes? Previous Surgical operations?

In case of Emergency if you cannot be reached:
Please Contact
Phone No.
Relationship to the child>