CBSE- i Application form (03.03)

CBSE -i List of Selected Candidates for Interview 2015-16
STD I
Date of Interview : 10 March 2015
Time 11. am
Venue: Conference Hall
SL No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
NAME
Brijit Rose
Michelle Mary Babu
Michela Rose Babu
Elvin Francis
Pranavraj K K
Michelle Tomi Fernandez
Muhammed Ayyan A B
Trina Ann Sinu
Aman Deepak
Shivani S
Devroop Moothedath
Akshaya A Manu
Avicka Rakesh
Aryan Menon K
Srisha T C
Antony Brinil
Aniketh Niranjan M
Berny Thomas
Bennet Thomas
Lian Sajith
Vaibhav Kishor
T.S. Roshan
Parvathy Menon
Adhrija C
Vivian Renoy
Karthika Mohandas
STD II
Date of Interview : 10 March 2015
Time 1.30 pm
Venue: Conference Hall
SL No.
1
2
3
NAME
Parvathy S Menon
J Sabareesh
Ahammednihal A N
STD III
Date of Interview : 10 March 2015
Time 1.30 pm
Venue: Conference Hall
SL No.
1
2
3
NAME
Sloka Ram
Shivsankar S
Zenhaparvin
STD V
Date of Interview : 10 March 2015
Time 1.30 pm
Venue: Conference Hall
SL No.
1
2
NAME
Adithyan V S
Yadukrishnan T
STD VI
Date of Interview : 10 March 2015
Time 1.30 pm
Venue: Conference Hall
SL No.
1
NAME
Nivea Radhakrishnan
STD VII
Date of Interview : 10 March 2015
Time 1.30 pm
Venue: Conference Hall
SL No.
1
2
N.B:
NAME
Aysha Sanam
Abhay S. Menon
The above listed candidates are requested to print the given application form, fill it and bring it
along with the requested documents for the interview.
To be filled by the Office
Form No:
Admission No:
Date of Admission :
APPLICATION FORM FOR CBSE-i
Application for admission to class ........... for the academic year 20
- 20
I. Student Profile:
1. Name in full (in capital)
______________________________________________
______________________________________________
2. Gender (M/F): __________
Blood Group: _____
3. Date of Birth :
____
(month)
_____
(date)
4. Age as on 1st June 20 ____
Please affix a recently
taken photograph of
the child
(date of photograph to be displayed
in the photograph)
____
(year)
year
months
5. Identification marks:
1. _____________________________________________________________________________
2. _____________________________________________________________________________
6. Place of birth:
District:
State:
7. Nationality of the child:
8. Religion:
9. Mother tongue:
10. Other languages known:
11. Languages commonly spoken at home:
Community:
Country:
12. Aadhaar No.
13. Passport details (for overseas students)
14. Visa/resident permit details where
applicable
II Particulars of previous schooling :
1. Name of the School:
2. Whether recognisd
If yes, specify the Board
3. Address
Web
4. Date of Joining:
5. Date of Leaving:
6. Class on Leaving:
7. Reason for Leaving
III Health
1. Serious illnesses if any,
with dates:
2. Present condition:
3. Dates of preventive inoculations:
4. Physical weaknesses/allergy,
if any, that require special
attention
IV Brothers and sisters (siblings) of the applicant studying/studied in Devamatha CMI Public School,
Thrissur.
Name
1.
2.
3.
Class
Year
V Details of Parents
To be filled by the father (or guardian
if the parents are no more)
(a)
(a)
Name
Name
Relationship to the
student: Father/
Guardian
Relationship to the
student: Mother/
Guardian
Father’s / Guardian’s
native place & State:
Mother’s / Guardian’s
native place & State:
Educational /
Professional
Qualifications
Educational /
Professional
Qualifications
Details of Colleges /
Universities attended
Details of Colleges /
Universities attended
Name & Address of
Company / Business /
Organisation
(Please specify
as applicable)
Name & Address of
Company / Business /
Organisation
(Please specify
as applicable)
Please elaborate
on the nature of
your work and
responsibilities
Please elaborate
on the nature of
your work and
responsibilities
Are you a NonResident Indian?
If so give details.
Are you a NonResident Indian?
If so give details.
Details of association
with Devamatha CMI
Public School
Details of association
with Devamatha CMI
Public School
Any other details you
consider important,
but are not covered
above:
Any other details you
consider important,
but are not covered
above:
c) Gross (pre-tax) annual income of the parents
Father / First guardian:
Mother / Second guardian:
d) If the parents are separated or divorced, please indicate clearly the legal status of the child in terms
of custody and access to parents and the arrangements between the parents regarding the visitation
rights or any other rights in conformity with the orders of the legal authority and school rules.
e) In such cases (those in which one of the parents has visitation rights or any other rights and the other
parent has custody) both the parents should sign the application form. (This application is liable to
be rejected and the admission is liable to be cancelled at any stage in case of any misstatement.)
f) If the parents are separated or divorced, please indicate the person responsible for payment of fees.
VI. Address for communication
Father / Mother / Guardian
Address
Phone (Res) with STD code:
Phone (Res) with STD code
Father
Mother
Fax :
Mobile:
E-mail (active)
VII. Exact location where the child resides:
Note: The following documents are to be produced at the time of admission.
a) Proof of Date of Birth –Date of Birth extract in original for class I, Certified copy of the birth extract
for other classes
b) Attested copy of the Passport, if any
c) Transfer certificate countersigned by the District Educational Authorities of the area./Regional
Officer, CBSE
d) Year-end School Report
We/I hereby state that I shall undertake the responsibility that my son/ daughter/
ward obey all the rules of the School and any modifications made from time to
time.
Signature of Guardian
Station:
For office use:
Signature of Mother
Signature of Father
Date: