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Index No. B1-099 Phone:(033) 25871815
H.S Code :
Sl. No. KAMPA HIGH SCHOOL
Affix
Passport size
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Duly attested
(Higher Secondary)
Application for Admission to Class XI & XII
Stream: Science & Arts
1.(a) Name of the Student (in BLOCK letters) :.
(b) Date of Birth :..( according to the Admit Card/Certificate of M.P or Equivalent Exam.)
(c) Nationality Caste . Sub caste .. (attach attested copy of SC/ST certificate)
(d) Residential Address .
2.(a) Fathers Name .
(b) Address
.. Tel No. (if any)..
3.(a) Mothers Name
(b) Address
.. Tel No. (if any)..
4.(a) Guardians Name .
(b) Address
.. Tel No. (if any)..
Occupation ..
5.
Name of the Examination
Passed
Roll No.
&
Year
Name of the
Board
Marks Obtained
Beng
Eng.
Math
Ph.Sc.
L.Sc.
Hist
Geo
Add.
Full
Marks
Marks
Obt.
Subject offered by the Institution:
A. Compulsory subjects: 1.Bengali 2.English 3.Environmental Science
B. Optional Subjects : 1.Physics 2.Chemistry 3.Mathematics 4.Biology 5.Computer Science 6. Modern Computer Application 7.Geography 8.History 9.Sanscrit 10. Philosophy 11. Education.
Sl. No. KAMPA HIGH SCHOOL (H.S)
Received an application form from .
Form No. on .
Signature of the receiving clerk P.T.O
6. Optional Subjects chosen by the student for seeking admission 1 2 3 4...
7 Name of the School previously attended ( In case of student migrating from Board other than W.B.B.S.E., the name of the board should be noted) ..
Declaration:-
I hereby declare that the particulars stated above are true to the best of my knowledge and belief. As the guardian of Sri/Smt
. I shall bear all responsibilities of him/her and shall co-operate with the school in respect of all matters related to him/her as a student of Kampa High School (H.S).
Date:. .. .
Signature of the Guardian
FOR OFFICE USE ONLY
Student Admitted to Class ..
Stream ...
for the Session
Head of the Institution
N.B. Attested copy of marksheet, Admit card and original school leaving certificates to be submitted with the filled-up form.