Admission Form 10+1 ( 2011-12)

Please fill in all required information in BLOCK LETTERS

Student Name: ________________________________________________________________________________

Fathers /Guardians Name: ______________________________________________________________________
Mothers Name: _______________________________________________________________________________
Mobile No. (Father): ______________________ (Mother) ______________________________________________
(Student) ________________________________ (Landline No.) _________________________________________
Correspondence Address /Hostel/ P.G : ______________________________________________________________
______________________________________________________________________________________________
Permanent Address: _____________________________________________________________________________
______________________________________________________________________________________________
PG required:

Yes

Transport required:

No

Yes

No

E-mail Father: ___________________________

E-mail Student: ___________________________

Date of Birth:

Sex :

DD

MM

YYYY

Male

Female

School Name: _________________________________________________________________________________

Physics

Chemistry

Grading/Percentage of 10th Class

Maths

Science

Grading/Percentage of 11th Class

Physics

Chemistry

(Please the course student wants

Maths

to join at Pi Scholastics)

Maths

Fathers occupation with designation _______________________________________________________________

Office Address ________________________________________________________________________________
I promise to abide by the rules & regulations of the institute. I will behave properly and will not indulge in any
mischievous activity inside the premises and understand that institute holds right to ban my entry in the class.

Students Signature
I fully understand the rules and regulations of the institute and I will co-operate with the management of Pi Scholastics
and I am responsible for the conduct of my child in the premises of Pi Scholastics and the test centre.

Parents Signature
SCO 16-17, 1st & 2nd Floor, Sector 20-D, Chandigarh
Ph.: 0172-6544444, 5025027, 3910727, 9216144327
E-mail : info@pischolastics.com Website : www. pischolastics.com

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here

Date.: ..

Students Name:..

Class.: .

Roll No:. .

Batch.: ..

Course :..

Authorized Signature