APPLICATION FORM for Young Scientiest Programme of YUva VIgyani KAryakram -

"YUVIKA-2019" of Indian Space Research Organisation

Personal Information Application reference number:28911

Name of Student : RISHAV KUMAR Date of Birth : 26-5-2005

Gender : Male Name of the Parent/Guardian. : RAJEEV

KUMAR

Communication Details

Present Address

House No./Street : 394, BALDEV SAHAY LANE, CHURCH ROAD

City : RANCHI

State / Union Territory : JHARKHAND

Postal / Pin Code : 834001

Permanent Address

House No./Street : 394, BALDEV SAHAY LANE, CHURCH ROAD

City : RANCHI

State / Union Territory : JHARKHAND

Postal / Pin Code : 834001

Contact Information

Mobile Number:7903927735

Email Address:Rishav40rishi@gmail.com
Academic Information

Any membership in Science Club/Space Club if Yes please give the details of
membership:No

Name of School with complete Postal Address: ST. JOHN&#39S ENGLISH MEDIUM SCHOOL,
KARBALA TANK ROAD, RANCHI

School where the school is located : JHARKHAND

Whether the school is located in a Panchayat Area(Yes/No): No

Name of the Board of Education(State/CBSE/ICSE/International/Others).: CBSE

Marks Secured/Total Marks in 8th Std:

Marks Obtained: 1399.8 Total Marks: 1600.0 % of Marks: 87.4875

Give Details: Prize in any school individual extracurricular activity(Elocuton/Debate/Essay

Writing,Science quiz,Computer modeling,Scientific prototype model making,etc.,) at
District/State/National/International Level(The higher level will be considered for
weightage)

Name of the International

Sl.No District Level State Level National Level
Activity Level

ELOCUTION
1) COMPETITIO First
N

SCIENCE First
2)
EXHIBITION

DEBATE
3) COMPETITIO First
N

SCIENCE
4) Third
EXHIBITION
* Winners of District/State/National/International Level sports activities (The higher level
will be considered for weightage)

Type of International
Sl.No District Level State Level National Level
Sports Level

1)

2)

3)

4)

Scouts and Guides/NCC/NSS Member, if any: No

Declaration of Parent or Guardian

I, being the parent/guardian of the student, give consent for him/her to attend the Young
Scientist Programme or "YUva VIgyani KAryakram - YUVIKA-2019 " if selected.

Signature of the Parent/Guardian

Declaration of Student

I hereby declare that the information furnished above is correct to the best of my
knowledge.

Signature of the Student Attested by

Signature of the Head Master/Principal(with Seal)

Date:

To complete the registration process follow the following instructions :

1. You are advised to download and print the filled application form.
2. The printed application form must be complete in all respects duly signed by the
candidate, Parent/Guardian and Head Master/Principal of the School.
3. Scan the signed application form and upload the same by logging into YUVIKA webpage
using your registered E-mail ID and yuvika password.