VIVEK VIDYALAYA Please affix your
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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. : ..................................................