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Application No: ______________
CHETTINAD HARI SHREE VIDYALAYAM
APPLICATION FORM FOR ISC – Academic Year 20______ - 20 ______
Name of Applicant in BLOCK LETTERS (as in Birth Certificate):
________________________________________________________________________________________
DD
Sex:
Male
Female
MM
YYYY
Date of Birth:
Residential Address : ______________________________________________________________________
______________________________________________________________________
Phone No
: ______________________________________________________________________
Admission sought for: Class 11
Class 12 (only for ISC students)
Father’s Name
: ______________________________________________________________________
Occupation
: ______________________________________________________________________
Office Address
: ______________________________________________________________________
______________________________________________________________________
Phone (Office)
: ______________________________________________________________________
(Mobile)
: ______________________________________________________________________
E-mail Id
: ______________________________________________________________________
Mother’s Name
: ______________________________________________________________________
Occupation
: ______________________________________________________________________
Office Address
: ______________________________________________________________________
______________________________________________________________________
Phone (Office)
: ______________________________________________________________________
(Mobile)
: ______________________________________________________________________
E-mail Id
: ______________________________________________________________________
Name and class of sibling/s (if any) studying in Chettinad Hari Shree Vidyalayam:
_________________________________________________________________________________________
Kindly specify the contact number and e-mail Id for correspondence with the school:
Mobile
: ______________________________________________________________________
E-mail Id
: ______________________________________________________________________
Name of School last attended: ________________________________________________________________
Identify examination board ( ICSE / CBSE / IGSE / Any Other ): _________________________________
(Students who have appeared for examinations other than the ICSE will be given only provisional
admission until the Council for the Indian School Certificate Examinations grants them eligibility
certificates to enroll for the ISC course.)
Qualifying Examination taken in year: _______________________________________________________
Does the applicant have any special needs that the school needs to be aware of?
(Use one additional sheet if necessary. Relevant reports need to be attached)
_________________________________________________________________________________________
_________________________________________________________________________________________
Did the applicant drop Mathematics or one / all of the Sciences in Std 9? If so, mention the subject(s) and
briefly explain why. (Use one additional sheet if necessary)
_________________________________________________________________________________________
_________________________________________________________________________________________
On a single A4 sheet provide a brief summary of significant extra-curricular activities and
accomplishments. Indicate level (intra-school, inter-school, district, state or national) where appropriate.
Please do not enclose copies of certificates.
The following electives are offered to the candidates applying for Std XI.
English is a compulsory subject and students have to opt for 4 more electives:
Electives Column 1
1
Mathematics
2
Physics
Column 2
Business Studies
Commerce
3
Chemistry
Accounts
4
Biology
Computer Science
Column 3
History
Psychology
Art
Sociology
Economics
Students should submit two choices of combination of subjects clearly mentioning them as Preference 1
and Preference 2.
FOR CHOICE OF ELECTIVES:
For Electives numbered 1 to 4 in the above table, students are to choose any one subject from the
respective row. The electives offered will be subject to number of students opting for the combination and
other timetabling constraints the school might face. In case the school is unable to offer the first
preference the students may be offered the second preference.
When making the selection please keep in mind the course requirement for undergraduate study.
Kindly fill in your preferences in the space provided below:
Electives
Preference 1
Preference 2
1
2
3
4
Before submitting your application form make sure you have enclosed attested photocopies of:
o The mark sheet of the school Final Examination conducted for Std IX & X
o Birth Certificate
o Reports if child has been previously assessed for learning disability or behavioural issues
The following documents have to be submitted on confirmation of admission:
o X Mark Sheets (inclusive of marks sheet from the Examining Board)
o Transfer Certificate
o Migration Certificate from previously attended Board
o Pass Certificate
o Students may apply for a change of subject options no later than two weeks of commencement
of school.
SUBJECTS WILL BE OFFERED ONLY IF A VIABLE NUMBER OF STUDENTS APPLY
LAST DATE FOR SUBMISSION OF FORMS: _________________
INCOMPLETE APPLICATION FORMS WILL NOT BE CONSIDERED.
Admission is subject to confirmation only after the statement of results in the qualifying
examination from the respective Board and Transfer Certificate has been submitted.
Declaration:
I declare that the information furnished by me is true to the best of my knowledge and belief. I promise that,
if given admission, I will abide by the rules and regulations of Chettinad Hari Shree Vidyalayam. I
understand that if I am found to have falsified or inaccurately presented any information about myself, my
admission is liable to stand cancelled.
Signature of Applicant: ________________________________
Date: ______________
Signature of Parent/Guardian: ___________________________
For any clarification contact: 044 - 2461 5254 / 2461 5264 / [email protected]
Note: Kindly submit the completed form along with required documents and Rs.300/- to the
school office during working hours.
For office use only:
Application Number: ____________________________________________________________
Documents pending for submission: ___________________________________________________
Status of Admission: _____________________________________________________________