Admission for session 2020-2021 is open . Please Register from our website to confirm you Admission.

Kesaibahal


Kuchinda,Odisha

Mobile No.


7504095770

Admission Form



Father's Passport Photo (image jpeg formate, max size: 200kb) *
Father Name *
Phone/Mobile No *
Student's Passport Photo (image jpeg formate, max size: 200kb) *
Student Name *
Phone/Mobile No *
Mother's Passport Photo (image jpeg formate, max size: 200kb) *
Mother Name *
Phone/Mobile No *

1.Name of the Applicant
First Name *
Middle Name
Sur Name *

2.Student's Adhar Number *
3.Select Gender *

4.Date of Birth (As in Birth Certificate) *
Date of Birth in Words *

5.Age on Date of Admission *

6.Religion *

7.Nationality *

8.Mother Tongue *
9.Disadvantage Group *
10.Physical Disability * If Yes, Type of Disability

11.Student's Bank Account No. *
12.Bank Name *
IFSC
Branch


13.Father's Name *
14. Occupation of Father *
Father's Age *
15.Father's Adhar No *
16.Father's Mobile No *
Father's Email
17.Father's Annual Income *



18.Mother's Name *
19. Occupation of Mother *
Mother's Age *
20.Mother's Adhar No *
21.Mother's Mobile No *
Mother's Email
22.Mother's Annual Income *

25.Complete Present / Postal Address *

Name
Village / Town
Post Office
Via
Police Station
District
State
PIN

26.Permanent Address *

Name
Village / Town
Post Office
Via
Police Station
District
State
PIN

27. Name and Complete Address of Local Guardian *

Name
Village / Town
Post Office
Via
Police Station
District
State
PIN

Academics

28.Class in which Admision is Desired *
29.Name and Address of Institution last attended *

30. Birth Certificate Details *

Birth Certificate No.
Birth Certificate Date *

31. T.C. Details

T.C. No. *
T.C. Date *


32.Languages Known *

33.Performance Record of Last Year : % of marks secured *

34.If Admitted, The applicant proposes to reside : *

35. Upload Medical Certificate(image jpeg formate, max size: 200kb) *

Disease (if any): Give Details










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