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RAJAGIRI HIGHER SECONDARY SCHOOL
Rajagiri,Kalamassery- 683 104, Phone : 0484-4111401
APPLICATION FOR ADMISSION 
TO THE HIGHER SECONDARY COURSE (Classes 11 & 12)
 
(Fields marked with * are mandatory)
1. Name of applicant(IN BLOCK LETTERS)*             .
2. Year(s) of the Course
3. Gender*
4. Age & Date of birth*
Age  Date of Bith
5. Place of Birth(with Dist. & State)*
Place of Birth District State
6. Place of Residence
Place Panchayat/Muncipal town/ Corporation Taluk District
7. Name (IN  BLOCK LETTERS) & Ocupation of Father/Mother/Guardian*
8. Permanent Home Address of the Parent/Guardian with Pincode*
9.

Address to which communications are to be sent with Pincode

10. Religion and Caste  
11. (a) Contact Phone No. with STD Code*
12. Mobile*
13.

Email

14. Whether belongs to (tick the relevant column)*
15. Whether the applicant is(tick the relevant column)
16. Are You Eligible for bonus score(tick the relevant column)
17. Are You Eligible for reservation under Sports Quota : Sports and Games Winner.
18. Prizes won in
19.

Details of participation in co-curricular activities (Red Cross,Social Service Club,Science Club,Environment Club,Forestry Club,Philately Club,Debating Club,Oratory Club etc.)

20. Whether the applicant is eligible for educational concessions from Government
if Yes ,furnish details
21 Name and address of the school in which the applicant studied for the S.S.L.C or equivalent examination
22. Courses study in class 10*
23. a) No.of chances taken for passing the SSLC or equivalent examination
b)Reg . No,Month & year of appearance
24. Number and date of T.C issued from the institution last studied
25. Group and Subjects Combination(tick the relevant group) *
26. Second Language chosen under Part II (tick the relevant column)*
27. DD No*
28. DD Date*
29. Bank Name*
30. Grade/Marks of Qualifying Examination(Self attested Photostat copies of the SSLC/Equivalent Examination to be enclosed)*
Subjects Lang-1 Lang-11 Eng. Hindi

Social Science

Phy. Che. Bio. Maths IT
Maximum Score
Score obtained
Grade
 
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