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VIVEK VIDYALAYA Please affix your
photo here
CHHOTA GOVINDPUR, JAMSHEDPUR-831 015
(Affiliated to Central Board of Secondary Education, Delhi)

APPLICATION FOR ADMISSION IN CLASS

Form No. .......................... Date: ..........................

1. Class Applying For:..................................................................................................

2. Name of the Student.......................................................................................................

3. Date of Birth (As per School Cerificate) (In Figure).........................................................

(In Words)........................................................................................................................

4. Individual Medical Card No. (In case of T.M.L./TCL)........................................................

5. a) Father’s Name (in block letters)...................................................................................

b) Mother’s Name (in block letters)................................................................................

c) Ticket No./Occupation.................................................................................................

d) Official/Occupational Address....................................................................................

.........................................................................................................................................

Telephone (Office) ........................ Residence......................... Mobile ..........................

6. Gross monthly income (parent) .....................................................................................

7. Present Address..............................................................................................................

8. Permanent Address.........................................................................................................

.........................................................................................................................................

9. General/Schedule Caste[ ]/Schedule Tribe [ ]/ Other Backward Class [ ]........................

10. a) Name of the School last attended...............................................................................

b) Whether recognized by State Board/C.B.S.E/I.C.S.E...................................................

c) Name of Examination appeared..................................................................................

d) Whether as a regular student/private student...........................................................

e) Medium of instruction at the last school attended.....................................................

f) Marks scored in last exam (/out of)......................................................................................

10. Siblings admission no.:

Sibling 1: .........................................................................................................................
Sibling 2: .........................................................................................................................
Sibling 3: .........................................................................................................................
Sibling 4: .........................................................................................................................
Sibling 5: .........................................................................................................................

Signature ....................................

Office Details

Received Date: ............................................

All certificate attached: YES/ NO

Admission Taken: YES/ NO

Admission No.: ........................................ Class: ....................................................

Roll No. : ..................................................