Form Download
Form No. ....................... Estd.-1919
|
Paste recent passport size colour photo |
ISLAMPUR HIGH SCHOOL
(Govt. Spons.)
(Higher Secondary - Gen. Stream)
P.O. - Chaulkhola :: Dist. - Purba Medinipur :: PIN - 721455
Application Form for Admission to H.S. General Stream Course (Science & Arts) for the year 20........
TO BE FILLED BY THE CANDIDATE
1. Name of the Student (Block Letters)................................................................................................................................... Aadhaar No. ............................................................................................... (self attested xerox copy to be submitted)
2. a) Father’s Name....................................................................................................................................................................
b) Mother’s Name..................................................................................................................................................................
c) Guardian’s Name..............................................................................................Occupation.................................................................................
Mobile No. :......................................................................
3. Address of the Guardian : a) Present : Vill...............................................................P.O..............................................................P.S..................................... Dist...................................................................................................................PIN..........................................................
b) Permanent : Vill.........................................................P.O...................................................P.S......................................... Dist...................................................................................................................PIN..........................................................
4. Date of Birth ...................................................................... (Self attested copies of the Madhyamik Admit Card & Certificate to be submitted)
5. a) Whether SC/ST/OBC/PH (Self attested copy of Caste Certificate to be attached)
b) Sub Caste ............................................(c) Nationality ..........................................(d) Religion....................................
6. Passed the Madhyamik Examination in ..............................................................from.................................................... .................................................................................School in the year................................................................................. bearing Roll .......................................................................................No..............................................................................
7. Marks Secured in Madhyamik Examination : (Self attested copy of the Marksheet should be submitted) : [Original copy of Character Certificate from the Head of the Institution last attended (passed from other Institution) to be submitted]
| BENG | ENG | MATH | P.SC. | L.SC. | HIST | GEO | ADDI. | TOTAL | GRADE |
8. Class to which admission is sought ....................................................................................................................................
9. Yearly income of the father / guardian .................................................................................................................................
10. Select any four Elective Subjects either from Group - A or from Group - B. [Don’t mix Group-A with Group-B]
Group - A : (1) PHYS / NUTN, (2) CHEM./ECON., (3) MATH, (4) BIOS, (5) GEGR
Group - B : (1) NUTN, (2) ECON., (3) HIST. / MATH, (4) GEGR / HMFR
N.B. Minimum marks needed for the following subjects : (1) MATH, PHYS - 60% in Math, P.Sc. (2) CHEM, BIOS - 50% in P.Sc., L.Sc. (3) GEGR - 40% in Geography
11. Subjects to be taken up : Compulsory Subject : (1) Bengali, (2) English
Elective Subject : 1)..............................................................., (2) .......................................................................
(3) ..........................................................., (4) ........................................................................
I undertake to abide by all the rules and regulations of the Institution. .................................................... ..............................................................
Signature of the Student Signature of the Father / Guardian
Date :............................... Date.......................................
........................................................................................................................................................................................................................................................................................................................ RECEIPTS
Form No. -
Name of the Applicant ........................................................................................................ ................ Admission sought for Class - XI.
Date................................ Signature of Receiving Authority