APPL. NO. : Admn. No.

SRI CHAITANYA JUNIOR COLLEGE

COLLEGE CODE: 05137
RC. NO. : 009/NJC/E1-2/KR/2013-14 DATED 28/08/2013
PUNADIPADU, KANKIPADU MANDAL KRISHNA DT – 521 151
APPLICATION FOR ADMISSION INTO I / II YEAR INTERMEDIATE.........................

1. Name of the Applicant in Full : ..................................................................................

(in Block Letters with surname)

2. Name of the Parent / Guardian :.............................................................

3. Name of the Mother :............................................................. Photo to be
Affixed
4. Occupation and Annual income of here
Parent / Guardian................................... .............................................

5. Full Postal Address of Parent / Guardian (in Block Letters)

Name :............................................................................................
Door. No :...................................Street/Colony......................................
Station : (P.O.).........................District :...............................................
Photo to be
Pin Code :....................................Phone : ............................................... Signature of the Candidate
affixed
6. Date of Birth :...................... Mother tongue :.................................... here
(as per S.S.C.)

7. Place of Birth :.......................... District ................................ State ......................................

8. Nationality ............................. Religion ............................... Caste : SC/ST/BC/OC

Adhar UID No ___________________________ Sub Caste : ……………….

9. DETAILS OF QUALIFYING EXAMINATION

a) Month and Year of Passing S.S.C./C.B.S.E/I.C.S.E/A.I.S.S.E/A.I.S.L.C. :........................................
b) Name of the School and Place where Studied : ............................. ...................................
c) Marks Obtained in ( I ) English :...............( II ) Telugu :.....................( III ) Hindi : ....................
(IV) General Science :..................(V) Mathematics :...................(VI)Social..................Total ..................

10. Subjects Proposed for Study in Intermediate :

MPC
Telugu
Language :.......................... Group :...................BIPC Medium :
(under part II) (under part III) English
MEC

I promise to abide by the Rules, Regulations and orders of the Board of Intermediate Education and the
College, its authorities and officers during my tenure in the institution.

Date :.......................... Signature of the Candidate

I agree to applicant’s admission in this college. I shall be responsible for the payment of her fee and other
charges. I shall be responsible for her conduct and good behaviour during the period of her stay in this institution. I
declare that the statements made in this application are true and correct to the best of my knowledge.

Date : .................... Signature of the Parent/Guardian

Remarks :-
PRINCIPAL