DAV PUBLIC SCHOOL, SECL BISHRAMPUR SURAJPUR District - Surajpur, Chattisgarh - 497226

PROVISIONAL ADMISSION APPLICATION FORM

1. Registration for Class 2. Form No
3. Stream 4. Subject
5. TransactionID 6. Payment Status
Are you a student of DAV Model School, Bishrampur? Admission No

1. PERSONAL (CAPITAL LETTERS)
1. Name of the Student 2. Date of Birth
3. Dob (in words) 4. Mobile
5. Aadhar No. 6. Email
7. Nationality 8. Religion
9. Category 10. Language
11. Gender 12. Blood Group
13. Staff Ward 14. Permanent Address
15. Present Address

2. Parent/Guardian Detail
1. Father's Name
2. Education Qualification
(Mention Highest)
3. Occupation
4. Name Of the organisation
5. Designation
6. Address
7. Mobile
8. Father Aadhar No:
9. Father Email ID
10. Annual Family Income
11. Single parent
1. Mother Name
2. Education Qualification
(Mention Highest)
3. Occupation
4. Name Of the organisation
5. Designation
6. Address
7. Mobile
8. Mother Aadhar No:
9. Mother Email ID:

3. Previous School
1. Name of the School Last Attended with Address
2. Name of the Board 3. Registration No.
4. Board Roll No. 5. Year of Passing/Appearing

4. Educational Details
Subjects:
S.No Class X Term I CLASS X Pre-Board I/II Class X Final
Subject (Full marks) (Marks obtained) (Full marks) (Marks obtained) (Full marks) (Marks obtained)
English
Mathematics
Science
SST
Average of Maths & Science ssss
Aggregate % (excluding 6th subject)

UNDERTAKING
NOTE: A particular subject option will be available only if there are minimum 25 students of that subject.
List of Documents to be submitted at the time of submission of Registration Form : -

01. Self attested copy of result/ marks statement of class X final.

02. Copy of Aadhar card of mother , father and candidate.

03. Declaration form of SECL And non SECL candidate

04. Blood group certificate of outsiders candidate.

05. Two photographs of candidate..

06. Single girl child affidevit ( if any ).

DECLARATION I / We hereby certify that the above information provided by me / us is correct and I / We understand that if the information is found to be incorrect or false, the ward shall be automatically debarred from selection / admission process without any correspondence in this regard. I / We also understand that the application / registration / short listing does not guarantee admission to my ward. I / We accept the process of admission undertaken by the school and I / We will abide by the decision taken by the school authority. I / We understand that :

  • This admission is purely provisional and will be confirmed on submission of documents and subject to acceptance of the candidature by CBSE / Other Boards.
  • I hereby declare that the particulars given in respect of my son / daughter / ward are true to the best of my knowledge and I shall not request the authorities of any alteration in date of birth etc. given above.
  • My ward will attend the class regularly and as per CBSE norms he / she will fulfill the criteria of attendance i.e. 75 % (minimum)
  • My ward will pass subjectly as well as aggregate in all the examinations held during the session.
MOTHER FATHER LOCAL GUARDIAN (if father / Mother is not the guardian)
Signature ______________ Signature ______________ Signature ______________
Name ______________ Name ______________ Name ______________
Date ______________ Date ______________ Date ______________

Office Use Only
Allottted Admission No
Date Of admission
Fees Paid(Rs.)
Receipt No
Fees Paid Date