Vallipurathanpalayam, Erode - 112. School Application No. (for office use): ADMISSION FORM 20 - 20 (PLEASE COMPLETE USING BLOCK LETTERS) S.No 1 Particulars To be filled First Name of the Student Initial / last name 2 Sex 3 Date of birth in figures (dd/mm/yyyy) Date of birth in words (Photocopy of birth certificate to be attached) 4 Nationality and state 5 Religion & community 6 Does the pupil belong to BC, SC or ST? 7 Mother tongue of pupil 8 Blood group 9 Disabilities / Handicap 10 Medical diagnosis / Current medications 11 Whether living with parent or guardian? 12 Name of the father / guardian 13 Father's educational qualifications 14 Father's occupation 15 Name of the mother 16 Mother's educational qualifications 17 Mother's occupation 18 Residential address 19 Communication address (if different from above ) 20 Primary mobile number for school messages 21 Secondary mobile number for school messages 22 Email address to send school messages 23 Yearly income of father and mother (total) 24 Class last attended. (Mark list from the previous school to be attached) 25 Name of the school last attended 26 Was the above school recognized by the CBSE or by the State Department ? Rs.___________________ / Annum 27 Medium of instruction of school last attended 28 Whether qualified for promotion 29 Class into which admission is sought 30 Any awards received in sports or co-curricular activities? 31 Choice of Second language 32 Second language in previous school 33 Choice of Third language 34 Siblings studying in CS Academy (name & class details) 35 Siblings applying to CS Academy along with this application (name & class details) 36 Are any of the parents employees of CS Academy? If so, which department? 37 Is school lunch required ? 38 Is school transport required ? If yes, please state the pick up location. 39 Is hostel facility required ? If yes, please fill the hostel application form. (Only for boys) 40 Is CEP** course required (for classes VIII onwards) 41 Does the Parent/ Guardian agree to pay the tuition fee for one full year, in case the child is withdrawn part way during the year? 42 Reference if any Class __________ Group* ________(For Std XI) ** Competitive Exam Preparatory course I hereby declare (a) that the details furnished above are correct (b) that I will not demand any changes to the date of birth given above and ( c) that I shall abide by the rules of the school. _______________________ Guardian / Parent's Signature Date : For Office use only : List of documents to be attached at the time of admission 1) Passport size photo - 2 nos. 2) Transfer Certificate from previous school. (Number & Date:______________________) 3) Birth Certificate (Original) 4) Community Certificate(Photocopy) Record purpose Standard & Section: _______________ Student ID No.: ___________________ ______________________ Verified by Record Keeper ________________________ Principal / Vice Principal Vallipurathanpalayam, Erode - 112. School Application No. (for office use): GROUP SELECTION FORM *Groups offered for Std XI : Group I-a : Physics, Chemistry, Mathematics, Biology & English (Medical) Group I-b : Physics, Chemistry, Computer Science, Biology & English (Medical & Engineering) Group II : Physics, Chemistry, Mathematics, Computer Science & English (Engineering) Group III-a : Economics, Accountancy, Business studies, Mathematics & English (Commerce) Group III-b : Economics, Accountancy, Business studies, Computer Science & English (Commerce) Date : _______________________ Guardian / Parent's Signature Vallipurathanpalayam, Erode - 112. School Application No. (for office use): APPLICATION / ADMISSION FORM FOR THE CS HOSTEL (PLEASE COMPLETE USING BLOCK LETTERS) S.No 1a Particulars To be filled School Application Number (For new students) (Or) 1b Student's ID Number (For existing students) 2 Local Guardian’s Name & Address 3 Relationship with the student 4 Local Guardian’s Contact Number 1 5 Local Guardian’s Contact Number 2 6 Vegetarian or Non – Vegetarian 7 Any food allergies, Yes/No. If yes, to be given in writing 8 Week boarding or Full boarding I hereby confirm that all the information given above is true and take full responsibility for my ward. I also agree to pay the full year’s fee, in case the child is withdrawn part way during the year. _______________________ Guardian / Parent's Signature For Office use only : Comments Status Waitlist Priority: HP / MP / LP Reject / Waitlist / Admit Admit to class: ______ Authorised Sign.:_________________ List of documents to be attached 1) Passport size photo - 2 nos. Record purpose Standard & Section: _______________ Student ID No.: ___________________ ________________________ Principal / Vice Principal
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