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Board Index : I1-018   H.S. Code : 115142     NIOS Code : 460502     Voc Code : 5584

          BARASIJA HIGH SCHOOL (H.S)   

                 P.O.- Barasija, Dist.:- Birbhum       PIN:- 731234

            Phone: 8145584365       Application For  Admission  to class …………

                                              Academic year : 20…………

 

                                               (Fill-up the form in Block Letter)

 

Name of the Applicant:…………………………………………………………………………………………………….

Date of Birth :(As per Birth Certificate/T.C/ M.P Admit Card)…………………………………………

Fathers’ Name:………………………………………………………………Occupation :…………………………….

Mothers’ Name:……………………………………………………………………………………………………………….

Guardian’ Name :…………………………………………………………………………………………………………….

Address :-   Vill:……………………………………………P.O.:………………………..Dist.:………………………….

Gram Panchayet :………………………………………P.S.:………………………PIN:………………………

Contact Number :………………………………………………Aadhaar No………………………………………….

Name of the School Last attended :………………………………………………………………………………….

Class to which the applicant seek admission :………………………………………………………………….

Marks Obtained in M.P

Life Sc.

Marks Obt.

 

 

 

 

 

 

 

Choice of subjects : (Applicable for H.S Course only)

i)……………………………ii)……………………………iii)……………………iv)………………………(Compulsory Elective

Subject) .

[Four subjects to be chosen from the list below: Arabic, Computer Science, Computer Application,

Geography, History, Health& Physical Education, Philosophy, Political Science , Mathematics,

 Physics , Chemistry , Biology, IT-ITeS, Automobile ]

     12.  Cast. : Gen/SC/ST/OBC-A,OBC-B, (Attach Xerox copy of the original certificate where                    

                                                                                                                                               necessary )

 C.W.S.N:- YES/NO (If Yes attach valid proof if possible)

Do you belong to a family  under BPL category : YES/NO(If Yes attach Xerox copy of the                                 

                                                                                                            Valid  BPL certificate )

 Bank Account Details :

Name of the Bank :…………………………………………………………………………………………………………..

IFSC Code……………………………………………………., Branch:……………………………….……………………

(Attach Xerox copy of the Bank Passbook)

Declaration: I, the undersigned do hereby assure that I would abide by all the rules and regulations

of the institution if I get admission to the institution.

 

Counter signature of the Guardian with dateSignature of the Candidate with date

 

 

Signature of the Headmaster with remarks.