Directorate of Higher Secondary Education Single Window Admission 2011 Application for Renewing Candidature

1 Application No.(as shown in the Acknowledgement slip) : 2 Name of Applicant 3 Scheme of Qualifying Examination 4 SSLC Reg No. and Year of Pass 5 Address for Communication : : : :

6 Contact Telephone Number 7 Options for Supplementary Allotment (Check the vacancy position before filling up the options) Preference Number School Code

Combination Code

(Attach separate sheet for adding more options)

Date: Place:

Name & Signature of the Applicant

Name & Signature of the Parent

For Office Use Only Name and Code of Data Entry school Data Entered by Verified by