|
(Admission
will be strictly against vacancy) |
Please Affix Latest Passport
Size Photograph in color.
(png/jpg) *
STUDENT
Please Affix Latest Passport
Size Photograph in color.
(png/jpg) *
MOTHER
Please Affix Latest Passport
Size Photograph in color.
(png/jpg) *
FATHER
|
GENERAL INFORMATION
|
I / We are Considering enrolment in Grade/ Class
with effect from
month/year.
Have you ever applied for admission at G.D.Goenka Schools
Yes
No
If Yes when? Academic Year
for which Class
|
PERSONAL DATA OF STUDENT
|
SURNAME
FIRST NAME*
MIDDLE NAME
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Date of Birth *
Age as on 1st April
Nationality
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Sex: Male
Female
Mother Tongue
Languages Spoken at home
|
Permanent Address *
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City *
Pincode
Country
Email address *
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Home Tele#
Mob# *
Emergency Contact No
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Mailing Address If different
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HEALTH INFORMATION
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Allergy/ Chronic ailment: If any
Physical handicap/ disability: If any
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Any other health problem
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EDUCATIONAL BACKGROUND
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Name of previous and present school attended
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City/State
Country
From
To
Reason for leaving
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Has the child ever been Expelled/Rusticated/Not promoted to next class by any School ?
Yes
No
If Yes, Please give details:
|
PARENTS/ GUARDIANS INFORMATION
|
Father's/ Guardian's Name
Age
Nationality
Education/ University
|
Mother's Name
Age
Nationality
Education/ University
|
Relationship with child
Are parents living together
Yes
No
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PROFESSION/ OCCUPATION
|
FATHERS/ GUARDIANS Profession/ Occupation
Annual Income
|
Office Address
|
Telephone
Fax
Mobile#
Email
|
Mothers Profession/ Occupation
Annual Income
|
Office Address
|
Telephone
Fax
Mobile#
Email
|
OTHER RELATIVES INFORMATION
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Real Brother/ Sister 1. Name
Age
School attending/attended
|
Real Brother/ Sister 2. Name
Age
School attending/attended
|
Relatives who are studying/have studied in the G.D. Goenka Schools
|
Name
Class
Year of Joining
Relationship
|
REFERENCES
|
Name
Designation
Telephone
|
Address
City/State
Pincode
|
Name
Designation
Telephone
|
Address
City/State
Pincode
|
TRANSPORT
|
School Bus Facility
Yes
No
|
|
|
|
No (for office use)
|
|
|
Please attached following documents with this from:
- Attested copy of birth certificate.
- For Class III and above, previous 3 years report cards.
-
For Class III and above, Transfer Certificate to be produced at the time of admission.
In case of inter state students, the Transfer Certificate shoud be counter signed by the
education officer.
- Visiting/Business Cards of parent
- Passport size photographs
(1 each of student and both parent/guardian )
DECLARATION/ UNDERTAKING:
This from is intended to furnish information about the student and his/her family, without obligation
on either side.
I/We Understand that:
If we wish to proceed further all entries in the Application form must be completed.
I/We certify that the information furnished in this form is true to the best of my/our knowledge and belief .
Signature of Parent/ Guardian
For Office Use Only
|
G. D. GOENKA PUBLIC SCHOOL
R.K. Puram, Khagual Road, Saguna More, Patna
Tele-7781004161-63
CORP. OFFICE -
303, 3rd Floor, Kamala Business Park
(Reliance Trends Building).Boring Canal Road,Patna
Tele:- 0612-2531000, +91-9771459848
info@gdgoenkapatna.com
|
|
Payment Details |
Application Form Fee |
INR 1000
|
Registration Charges
|
INR 2000
|
Total Fee |
INR
3000
|
|
In case of any difficulty in submitting the form, please call on helpline 7781004162 |
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