Gurukul Vidya Mandir Secondary School

Application for Admission in Class

Session

No.

1

Student Name

2

(a) Date of Birth

(b) Sex

Male Female

(c) Religion

Mother Tongue	Bengali Hindi	Caste	SC ST OBC GEN
Blood Group		2nd Language	Bengali Hindi

3

Father's Name

Qualification

Occupation

Income: PM

Office Address

4

Mother's Name

Qualification

Occupation

Income: PM

Office Address

5	Residential Address
	Phone		Mobile

6

Name of the Guardian(If the child is not staying with parent) & Address

Mobile

7

Details of Child's Brother / Sister (if any)

8	Last School Attended
	Class	T.C. No
9	Special Interest if any

Date	Guardian's Signature	Mother's Signature	Father's Signature

*A xerox copy of (i) Birth certificate (ii) Cast certificate (iii) Immunization & Blood Group (iv) Last Report Card (v) Aadhar Card of the Student must be enclosed with this application

Date of Issue

Date of Submission

Date of Interview

FOR OFFICE USE

Date of Admission

Recomended

Admission to Class

Sec

Roll No

Registration/Admission No.

ADMIT CARD

Name of the Student		Class
Interview / Admission Test on		Time