Cambridge Public School (10+2)

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CAMBRIDGE PUBLIC SCHOOL (10+2)

Ranchi Road Redma, Daltonganj, Mob.No.8092535389, 9934512437

(CBSE Syllabus, Co-Education, English medium, Visit: -www.cps.micet.in)

(FOR OFFICE USE ONLY)

Reg. No.

Sub.

School No.

Remarks

               

(SCIENCE / COMMERCE)(To be filled by Parents/Guardians)

1.            Student’s Name (in block Letter)……………………………………..

2.            Mother’s Name ……………………………………………………………….

3.            Father’s Name (in block Letter)……………………………………..

4.            Guardian’s Name (in block Letter)……………………………………..

                Relationship with the student…………………………………………..

5.            Occupation (of father/guardian)………………. Annual income……

                Name,  address of the organization and designation, phone if any.

                ……………………………………………………………………………………………………..

6.            Address of father/guardian

                (a) Correspondence address                                                      (b) Permanent address

                 ………………………………………………..                                                ………………………………………………..

                …………………………………………………..                                              ……………………………………………….

                Pin …………….. Phone no ………………..                                         Pin …………… phone no ………………………..

                (c)           Telegraphic address ……………………………………………………………………………………………………

7.            (a) Pupil’s age, on 1st April………………… yrs.………………..month……………….

                (b) Date of Birth …………………………………. (c) Body weight………………… (d) Height……………………..

                (e) Any chronic diseases like Epilepsy, Bronchial Ashman etc. YES/NO

8.            (A) Mother tongue ……………………………………..

                (b) Religion ……………………………………………..

                (c ) Does the pupil belong to scheduled cast/tribe ?..........................YES/NO

9.            (a) Name and address of pupil’s pervious school ……………………………………………………………………

                (b) Whether the school is the recognized   by the Govt. Or not ……………………………………………..

                ( c) class in which the pupil was reading …………………………………………………………………………………..

                (d) His medium of instruction ………………………………………………………………………………………………..

10.          Attach the          (a) C L C, Photo copy (b) S L C, photo copy (c) Admit card photo copy

11.          Percentage of marks secured at the last Examination (Attach Marks Sheet)

12.          (A) Scholarship stipend, if secured…………………………………………………………..

                (b) Prizes secured for general proficiency,sport,music,painting etc……………

                (c) Special aptitude Recitation, elocution.Debate etc…………………………………

13.          Guardian’s declaration:

                I have read the general rules and regulation of the school as given in the prospectus and I am satisfied that they are good and necessary for the education of my ward. The statements made here are, to the best of my knowledge, true, I shall co-operate with the school authorities in every respect to on able them to educate my ward according to the prevalent rules and regulations or such others as may be framed from time to time. If withdraw my ward from the school before the end of a school-year: shall pay compensation for the remaining part of the year as per the rule.

 

 

Date…………………….. Sing. Of candidate’s …………………………….. Sing. Of the father/Guardian……………..