| VIDYASHRAM DIVYAJYOTI VIDYANIKETAN HIGH SCHOOL (XII) |
| 1. Name of the Student in Block Letters |
| 2. Session 20……………….20……………… Previous School ………………………………………………… |
| |
| Mobile : 9832479031 Index No- 103 & Institute Code (H.S.) - 108105 |
| VIDYASHRAM DIVYAJYOTI VIDYANIKETAN HIGH SCHOOL (XII) |
| Co-Educational (Govt. Sponsored) |
| P.O- Vidyashram, P.S- Dhupguri, Dist- Jalpaiguri Paste |
| Estd.- 1970 Stamp size |
| Photo |
| APPLICATION FORM FOR (CLASS XI) |
| |
| 1. Name of the Pupil (in block letters) : |
| 2. Father's / Husband's Name & Occupation : |
| 3. Mother's Name : |
| 4. Permanent Address : |
| 5. Nationality : Religion : Caste : Blood Group : |
| 6. Approximate monthly income of Father/Husband : APL/BPL : |
| 7. Bank Name and A/C. No. (if any) |
| Branch : IFSC : Aadhar No : |
| 8. Date of birth of the student (According to M.P. Admit card) : |
| 9. Year of Madhyamik Pariksha with Name of Board : |
| 10. The school in which the student studied last : |
| 11. Mobile No. of the Guardian : |
| 12. Kanyashree ID (For Girls' only) : |
| SUBJECT CHOOSEN : |
| 1st language : BENGALI 2nd language : ENGLISH |
| Elective subject 1 : 2 : 3 : |
| ELECTIVE SUBJECT CHOOSEN : |
| (HISTORY / GEOGRAPHY / PHILOSOPHY / EDUCATION / POL-SCIENCE / SANSKRIT) |
| Optional Subject : |
| MARKS OBTAINED IN M.P. OR EQUIVALENT EXAM. |
| Ben : Eng : Math : P.Sc : L.Sc : Hist : Geo : Addl : Total : Grade : |
| |
| ** I declare that the particulars furnished above are true. I further declare that if I get admitted, I will abide by |
| rules & regulations of the institutions. |
| |
| Signature of Father or Legal Guardian Signature of Applicant |
| Date : Date : |
| |
| For office use only |
| Date of Admission : Receipt No : Roll No : Class : Session : |
| |
| N.B. : Attach Xerox copy of i) Caste Certificate, ii) M.P. Admit & Mark sheet, ii) Bank Pass Book, iii) Aadhar card, iv) Ration Card |
