DELHI PUBLIC SCHOOL, RAIGARH City Off: Opp. Town Hall, Raigarh (C.G,) 496001, Campus : Kotrapali Village, Jamgaon Road, Raigarh (C.G.) Session 20__ -20__ Form No. Registration No. ‘Admission No. Receipt No. A. STUDENT PROFILE 4. Name(in CAPITAL Letters) 2. Date of Birth (in figures) 3. Date of Birth (in words) vays I 4. Age as on 1" April of Years Current year 5. Seeking Admission to Class 6. Gender Mate [i] Female 7. Caste cen sc si osc [J 8. Religion 9. Name & Phone No. of the school last attended 10. Last class passed/ attended with Result 41, Language Known English [] Hindi 12. Area of Interest Academics [nn] 13. Residential Address Sanskrit [I] German[] other [7 14, a) Is the candidate only child of the parents 15. For Class XI only 1) 2) Subjects Offered 3), 4) 5) Additional Subject B. PARENTS’ PROFILE FATHER MOTHER 4. Name 2. Educational Qualification 3. Occupation 4, Designation 5. Official Address Ph. Mob. Ph. Mob. 6. If school staff child, Name of the staff 7. a) Areas of interest in which parents can help b) If other, please specify C. Other Information Cultural [7] Academics[~] MedicalOther [7] 1. Want to avail Bus Facility Yes no [] If yes ,specify the location and fill in application Distance from school{ in km) 2. Want to avail Hostel Facility Yes |] No [J 3. Photo/attested documents to be submitted YES Ne REMARK a)3 passport size photographs |_| Hl of the Students b) passport size photographs [_] || of Parents-one of each ©) Birth Certificate 4 BA 4) Mark Sheet of last class fel Oo €) Caste Certificate CI f) Original T.C. LJ | D. Declaration 4. Iwish to admit my ward in Delhi Public School,Raigarh.| understand that acceptance of this application form is in no way guarantee of admission of my ward Delhi Public Schoo! Raigarh.| have read all the instructions and will abide by allthe rules, regulations and instructions of the schoo! (existing and issued from time to time).. 2. Nolegal case is pending n any court of awin respect to my child's custody. Signature: Name: Date: FOR OFFICE USE Admission Granted [J Not Granted [JJ] — Remarks Class of Admission Date of Admission, Fee Deposited on Signature of Accountant Signature of Principal