Admission Application Form - Higher Secondary (Classes 11-12) | CSI Bain School

Step 1: Student Personal Details

Please provide the student's details as per Transfer Certificate / 10th Mark Sheet

1) Name of applicant (in full) (BLOCK CAPITALS) * Enter name exactly as it appears in your 10th Mark Sheet or Transfer Certificate

2) Expansion of Initials

3a) Date of Birth (Christian Era) * As entered in Transfer Certificate

3b) Age (Years & Months) Auto-calculated from Date of Birth

4) Gender *

Male

Female

5) Nationality *

6) State to which the pupil belongs *

7) Place of Birth and District *

8a) Religion *

Christian

Muslim

Hindu

Others

8b) Church attending

8c) Caste (for statistical purpose) Certificate from Thasildar required for ST/SC/BC

9) Aadhar No. *

10) EMIS No.

18) Mother tongue *

Step 2: Parent / Guardian Details

Please provide details of Father, Mother, and Guardian (if applicable)

11) Father's Details

11a) Name of Father *

11b) Occupation *

11c) Address *

11d) Telephone No. *

11e) Annual Income *

II) Mother's Details

IIa) Name of Mother *

IIb) Occupation

IIc) Address

IId) Telephone No.

IIe) Annual Income

12) Guardian Details

To be filled only if father is not alive

Is father alive? *

Yes

No

12a) Name of Guardian *

12b) Occupation *

12c) Address *

12d) Telephone No. *

12e) Annual Income *

Step 3: Academic Information

Please provide details about your previous school and examination results

13) Date of leaving the School last attended

14) Public Examination appeared *

15) Date of passing the examination *

16) Register No. in the examination *

17) Regional Language studied in the high school *

19) Medium of instruction in High school *

21) Class last studied and Name of School last attended with reasons for leaving if discontinued

22) Whether a copy of the T.C. is attached *

Yes

No

Original to be produced at the time of admission

20) Marks in Matriculation or other equivalent examination *

Application not containing these marks will not be considered. Marks are to be attested by the Headmaster/Headmistress of a recognised school or by any gazetted officer.

Subject	Maximum Marks	Marks Obtained	Percentage	Action

TOTAL	0	0	0%

Name of Examination passed

Step 4: Course & Group Selection

Select your preferred language and subject group combinations

Step 5: Health & Extra-Curricular Details

Please provide health information and extra-curricular activities

25) Health Information

25a) Height (cm) *

25b) Weight (kg) *

25b) Has the student suffered any serious illness such as T.B., Malaria, Typhoid, Small Pox?

Yes

No

25c) Was she/he vaccinated? If so, when?

Yes

No

25d) Is he/she physically handicapped? Give precise information

Yes

No

A medical certificate is required for exemption from sports and games

25e) Identification Mark 1

25e) Identification Mark 2

26) Proficiency in Extra-Curricular Activities

26) Proficiency in extra curricular activities (attested copies of certificate to be attached)

27) Proficiency in Games and Sports

27) Proficiency in Games and Sports (Outstanding achievement alone should be mentioned - attested copies of certificate to be attached)

28) Extra-Curricular Activities

28) Extra curricular activities - Mention participation in debates, elocution and entertainment programmes (Drama, Music etc.)

29) Educational Attainment of Parents

Father's Educational Attainment

Mother's Educational Attainment

Step 6: Declaration & Preview

Please review all information and provide declaration

Declaration

I declare that the particulars given above are correct to the best of my knowledge and will abide by the rules of time.

I am aware that admission obtained on false information or by suppression of facts will be cancelled on detection at any time.

Place *

Date *

Signature of Student (Type your name) *

Signature of Parent/Guardian (Type name) *

I agree to the above declaration and confirm all information is correct *

Application for Admission into Higher Secondary Course