application form

Infant Jesus School
(Recognised by the Government of Karnataka)
Kadrimidri, Mugthihalli Post
Chikmagalur – 577 133
Class : ______________
Phone : 08262 - 224231
Mobile : 9845954111
E-mail: [email protected]
Website : www.ijsckm.org
Admission No. : ______________
Application for Admission
01. Name of the Student ………………………………………………………………………………
«zÁåyðAiÀÄ ºÉ¸ÀgÀÄ
02. Boy or Girl ………………………….………………………………………………………………
ºÀÄqÀÄUÀ CxÀªÁ ºÀÄqÀÄV
03. Date of Birth ……………………..….…..in words….…………………………………….…….
ºÀÄnÖzÀ vÁjÃRÄ
CPÀëgÀzÀ°è
04. Place of Birth …………………………………………………………………….…………………
ºÀÄnÖzÀ ¸ÀܼÀ
05. Father’s Name …………………………………………………………..……..……living/dead
vÀAzÉAiÀÄ ºÉ¸ÀgÀÄ
fêÀAvÀ/zÉʪÁ¢Ã£À)
06. Mother’s Name……………………………………………………………..…..……living/dead
vÁ¬ÄAiÀÄ ºÉ¸ÀgÀÄ
(fêÀAvÀ/zÉʪÁ¢Ã£À)
07. Qualification of the Father …………………………………………………………………………
vÀAzÉAiÀÄ «zÁå¨sÁå¸À
08. Qualification of the Mother ……………………………………………………………………..…
vÁ¬ÄAiÀÄ «zÁå¨sÁå¸À
09. Occupation of the Father ……………………………………………………………………..……
vÀAzÉAiÀÄ GzÉÆåÃUÀ
10. Occupation of the Mother ………………………………………………………………….………
vÁ¬ÄAiÀÄ GzÉÆåÃUÀ
11. Parents’ Annual Income……………………………………………………………………….……
ºÉvÀÛªÀgÀ ªÁ¶ðPÀ DzÁAiÀÄ
12. Religion……………………………………………Caste …………………….……….……………
zsÀªÀÄð
eÁw
13. Scheduled caste/Tribe ……………………………………………………….…….………………
¥Àj²µÀÖ eÁw/ªÀUÀð
14. Mother Tongue ………………………………………………………………..….…………………
ªÀiÁvÀÈ ¨sÁµÉ
15. Permanent Address
………………………………………………………….…….…………
SÁAiÀÄA «¼Á¸À
…………………………………………………………….….…………
………….……………………………………………………………….
16. Telephone No. (Landline)……………………….
zÀÆgÀªÁt ¸ÀASÉå
17. Mobile No 1)…………………………………………… 2)…………………..…………….….
ªÉƨÉÊ¯ï ¸ÀASÉå
18. Medium of Instruction ………………………………………………………………………………
¨ÉÆÃzsÀ£Á ªÀiÁzsÀåªÀÄ
19. Class to which admission is sought ………………………………………………………………
¥ÀæªÉñÀªÀ£ÀÄß ºÀÄqÀÄPÀÄwÛgÀĪÀ vÀgÀUÀw
20. Whether the student wants the school bus facility? ……………………………………………
«zÁåyðUÉ ±Á¯Á ªÁºÀ£ÀzÀ ¸Ë®¨sÀå ¨ÉÃPÉÃ?
I hereby request the above named student to be admitted to class…………………………
Date :
¢£ÁAPÀ
Signature of the Parent/Guardian
ºÉvÀÛªÀgÀ CxÀªÁ ¥ÉÇõÀPÀgÀ ¸À»
Particulars to be filled in by the School Office
Admitted to Standard ………………………………….
Date :
Signature of the Principal
School Seal