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MODERN CONVENT SCHOOL

NEAR HABIB HOSPITAL KHETASARAI JAUNPUR

Ph. 011 - 25061091
Photograph of the student
Photograph of the   father
Photograph of the mother

Information About Student

Name of the student (In block letter)

First Name
Middle Name
Last Name
Date Of Birth
Aadhar No.
Gender
Admission- Old
New

(a) Age as an 1st April of the Academic Year: Day Month year

(Day)
(Month)
(Year)

(Photocopy Of Birth Certificate Of M.C.D/T.c. To Be Enclosed)

Father's Name
Mother's Name
Sibling Status(if any)
Present Address
Nationality
Religion
Category-Gen.
OBC
SC/ST
Caste Category
Contact No.
Landline with area code
E-mail ID
Correspondence address

Previous Academic Record

Name of the last attended school with address
Class/Grade
Class Marks Obtained


Other Details

Father's educational qualification
Father's occupation
Aadhar No
Mother's educational qualification
Mother's occupation
Aadhar No

For Transport Requirement

Name of the Student
Residential address
Contact No.
(Please keep the school informed of the changes in the address and contact Numbers)
From where you go to know about our school?
By word of month
Through Newspaper
Our website
Any other source
Why did you choose our School?

Declaration of the Father/Mother/Guardian

I Hereby certify that the information given in the registration from by me is accurate and complete. I understand and agree that mis representation or omission of facts will lead to denial and cancellation of admission or expulsion. I have read and hereby agree to the Terms and Conditions enclosed with the registration form

Signature of the Father/Mother/Guardian
Date:____/____/_________

Note: Colored Photo-3, Aadhar Card Photocopy-2, Marksheet Photocopy-2, Transfer Certificate- Original.

application received for

For Office Use Only

Application No.
Name of the student
application received for class.
Date
Signature