APPLICATION FORM

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

BRAINSTORM SCHOOL OF NURSING

(Recognized by Govt. of T.S., Hyderabad)

NOTE: Affix recent

i) Application is to be filled in by the candidate in Passport size
his/her own hand writing. Photograph
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected
iii) English Medium Only

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Mother’s Name : __________________________

4. Date of Birth and also in words

: __________________________

5. Annual Income of the Parent/Guardian : Rs.________________________

6. Address :

For Communication Permanent

Pin Code Pin Code:

7. Contact Landline & Cell No. i)

ii)

Other Alternate Number i)

ii)

8. Sex : Male/Female

9. Nationality : Indian

Contd…2
 -- 2 --

10. Religion : Hindu/Muslim/Christian

11. Social Status (Caste) : SC/ST/BC/OC, Sub-Group

12. Qualifying Examination Passed : Intermediate/Equivalent

13. Medium of Study in Qualifying Examination : Telugu/English

14. Residential Status : Local/Non-Local

15. Parent’s/Guardian’s Occupation & Address :

16. Student Aadhar Card Number :

17. Ration Card Number :

18. Bank Account Number :

Name :

Branch :

19. Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D. No.
Dated:
Bank______________________

DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.

Place:
Date: Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
other fees of my ward.

Place:
Date: Signature of Guardian/Parent
 APPLICATION FORM

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

IMAGE SCHOOL OF NURSING

(Recognized by Govt. of T.S., Hyderabad)

NOTE: Affix recent

i) Application is to be filled in by the candidate in Passport size
his/her own hand writing. Photograph
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected
iii) English Medium Only

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Mother’s Name : __________________________

4. Date of Birth and also in words

: __________________________

5. Annual Income of the Parent/Guardian : Rs.________________________

6. Address :

For Communication Permanent

Pin Code Pin Code:

7. Contact Landline & Cell No. i)

ii)

Other Alternate Number i)

ii)

8. Sex : Male/Female

9. Nationality : Indian

Contd…2
 -- 2 --

10. Religion : Hindu/Muslim/Christian

11. Social Status (Caste) : SC/ST/BC/OC, Sub-Group

12. Qualifying Examination Passed : Intermediate/Equivalent

13. Medium of Study in Qualifying Examination : Telugu/English

14. Residential Status : Local/Non-Local

15. Parent’s/Guardian’s Occupation & Address :

16. Student Aadhar Card Number :

17. Ration Card Number :

18. Bank Account Number :

Name :

Branch :

19. Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D. No.
Dated:
Bank______________________

DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.

Place:
Date: Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
other fees of my ward.

Place:
Date: Signature of Guardian/Parent
 APPLICATION FORM

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

TELANGANA INSTITUTE OF MEDICAL SCIENCES AND TECHNOLOGY

(Recognized by Govt. of T.S., Hyderabad)

NOTE: Affix recent

i) Application is to be filled in by the candidate in Passport size
his/her own hand writing. Photograph
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected
iii) English Medium Only

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Mother’s Name : __________________________

4. Date of Birth and also in words

: __________________________

5. Annual Income of the Parent/Guardian : Rs.________________________

6. Address :

For Communication Permanent

Pin Code Pin Code:

7. Contact Landline & Cell No. i)

ii)

Other Alternate Number i)

ii)

8. Sex : Male/Female

9. Nationality : Indian

Contd…2
 -- 2 --

10. Religion : Hindu/Muslim/Christian

11. Social Status (Caste) : SC/ST/BC/OC, Sub-Group

12. Qualifying Examination Passed : Intermediate/Equivalent

13. Medium of Study in Qualifying Examination : Telugu/English

14. Residential Status : Local/Non-Local

15. Parent’s/Guardian’s Occupation & Address :

16. Student Aadhar Card Number :

17. Ration Card Number :

18. Bank Account Number :

Name :

Branch :

19. Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D. No.
Dated:
Bank______________________

DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.

Place:
Date: Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
other fees of my ward.

Place:
Date: Signature of Guardian/Parent
 APPLICATION FORM

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

APEX SCHOOL OF NURSING

(Recognized by Govt. of T.S. & T.S.N.M.C, Hyderabad)

NOTE: Affix recent

i) Application is to be filled in by the candidate in Passport size
his/her own hand writing. Photograph
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected
iii) English Medium Only

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Mother’s Name : __________________________

4. Date of Birth and also in words

: __________________________

5. Annual Income of the Parent/Guardian : Rs.________________________

6. Address :

For Communication Permanent

Pin Code Pin Code:

7. Contact Landline & Cell No. i)

ii)

Other Alternate Number i)

ii)

8. Sex : Male/Female

9. Nationality : Indian

Contd…2
 -- 2 --

10. Religion : Hindu/Muslim/Christian

11. Social Status (Caste) : SC/ST/BC/OC, Sub-Group

12. Qualifying Examination Passed : Intermediate/Equivalent

13. Medium of Study in Qualifying Examination : Telugu/English

14. Residential Status : Local/Non-Local

15. Parent’s/Guardian’s Occupation & Address :

16. Student Aadhar Card Number :

17. Ration Card Number :

18. Bank Account Number :

Name :

Branch :

19. Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D. No.
Dated:
Bank______________________

DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.

Place:
Date: Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
Other fees of my ward.

Place:
Date: Signature of Guardian/Parent
 APPLICATION FORM
Last Date for submission of
Duly filled in application

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

INDIRA SCHOOL OF NURSING

(Recognized by Govt. of Andhra Pradesh)
Hyderabad.
ENGLISH MEDIUM
NOTE:
i) Application is to be filled in by the candidate in
his/her own hand writing.
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected

Affix recent
Passport size
Photograph

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Date of Birth and also in words :___________________________

4. Annual Income of the Parent/Guardian : Rs.________________________

5. Address :

For Communication Permanent

Pin Code Pin Code:

6. Contact Landline & Cell No.

Contd…2

-- 2 --
7. Sex : Male/Female

8. Nationality : Indian

9. Religion : Hindu/Muslim/Christian

10.Social Status (Caste) : SC/ST/BC/OC, Sub-Group

11.Examination Passed : Intermediate/Equivalent

12.Medium of Study in Qualifying Examination : Telugu/English

13.Residewntial Status : Local/Non-Local

14.Parent’s/Guardian’sOccupation & Address :

15.Details of (Previous) qualifying Examination : Inter CBSE ICSE
(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D.No.
Dated:
Bank______________________
DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.
Place:
Date: Signature of the Applicant
DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
Other fees of my ward.
Plate :
Dated: Signature of Guardian/Parent
 APPLICATION FORM

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

GOWTHAMI SCHOOL OF NURSING

(Recognized by Govt. of T.S. & T.S.N.M.C, Hyderabad)

NOTE: Affix recent

i) Application is to be filled in by the candidate in Passport size
his/her own hand writing.
Photograph
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected
iii) English Medium only

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Mother’s Name : __________________________

4. Date of Birth and also in words

: __________________________

5. Annual Income of the Parent/Guardian : Rs.________________________

6. Address :

For Communication Permanent

Pin Code Pin Code:

7. Contact Landline & Cell No. i)

ii)

Other Alternate Number i)

ii)

8. Sex : Male/Female

9. Nationality : Indian

Contd…2
 -- 2 --

10. Religion : Hindu/Muslim/Christian

11. Social Status (Caste) : SC/ST/BC/OC, Sub-Group

12. Qualifying Examination Passed : Intermediate/Equivalent

13. Medium of Study in Qualifying Examination : Telugu/English

14. Residential Status : Local/Non-Local

15. Parent’s/Guardian’s Occupation & Address :

16. Student Aadhar Card Number :

17. Ration Card Number :

18. Bank Account Number :

Name :

Branch :

19. Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D. No.
Dated:
Bank______________________

DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.

Place:
Date: Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
Other fees of my ward.

Place:
Date: Signature of Guardian/Parent
 APPLICATION FORM
Last Date for submission of
Duly filled in application

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

ANDHRA M.P.H.W.(F) TRAINING INSTITUTE

Recognized by Govt. of Andhra Pradesh
Hyderabad.
TELUGU MEDIUM
NOTE:
i) Application is to be filled in by the candidate in
his/her own hand writing.
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected

Affix recent
Passport size
Photograph

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Date of Birth and also in words :___________________________

4. Annual Income of the Parent/Guardian : Rs.________________________

5. Address :

For Communication Permanent

Pin Code Pin Code:

6. Contact Landline & Cell No.

Contd…2

-- 2 --
7. Sex : Male/Female

8. Nationality : Indian

9. Religion : Hindu/Muslim/Christian

10.Social Status (Caste) : SC/ST/BC/OC, Sub-Group

11.Examination Passed : Intermediate/Equivalent

12.Medium of Study in Qualifying Examination : Telugu/English

13.Residewntial Status : Local/Non-Local

14.Parent’s/Guardian’sOccupation & Address :

15.Details of (Previous) qualifying Examination : Inter CBSE ICSE
(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D.No.
Dated:
Bank______________________
DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.
Place:
Date: Signature of the Applicant
DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
Other fees of my ward.
Plate :
Dated: Signature of Guardian/Parent
 APPLICATION FORM

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

APEX COLLEGE OF NURSING

(Recognized by Govt. of T.S., Indian Nursing Council, T.S. Nursing Council & Affiliated to
K.N.R.U.H.S)
Affix recent
NOTE:
i) Application is to be filled in by the candidate in
Passport size
his/her own hand writing. Photograph
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected
iii) English Medium Only

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Mother’s Name : __________________________

4. Date of Birth and also in words

: __________________________

5. Annual Income of the Parent/Guardian : Rs.________________________

6. Address :

For Communication Permanent

Pin Code Pin Code:

7. Contact Landline & Cell No. i)

ii)

Other Alternate Number i)

ii)

8. Sex : Male/Female

9. Nationality : Indian

Contd…2

-- 2 --
10. Religion : Hindu/Muslim/Christian

11. Social Status (Caste) : SC/ST/BC/OC, Sub-Group

12. Qualifying Examination Passed : Intermediate/Equivalent

13. Medium of Study in Qualifying Examination : Telugu/English

14. Residential Status : Local/Non-Local

15. Parent’s/Guardian’s Occupation & Address :

16. Student Aadhar Card Number :

17. Ration Card Number :

18. Bank Account Number :

Name :

Branch :

19. Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D. No.
Dated:
Bank______________________

DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.

Place:
Date: Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
Other fees of my ward.

Place:
Date: Signature of Guardian/Parent
 APPLICATION FORM
Last Date for submission of
Duly filled in application

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

APEX COLLEGE OF NURSING

(Recognized by Govt. of Andhra Pradesh
Hyderabad.
ENGLISH MEDIUM
NOTE:
i) Application is to be filled in by the candidate in
his/her own hand writing.
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected

Affix recent
Passport size
Photograph

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Date of Birth and also in words :___________________________

4. Annual Income of the Parent/Guardian : Rs.________________________

5. Address :

For Communication Permanent

Pin Code Pin Code:

6. Contact Landline & Cell No.

7. Sex : Male/Female

8. Nationality : Indian
9. Religion : Hindu/Muslim/Christian

10.Social Status (Caste) : SC/ST/BC/OC, Sub-Group

11.Examination Passed : Intermediate/Equivalent

12.Medium of Study in Qualifying Examination : Telugu/English

13.Residewntial Status : Local/Non-Local

14.Parent’s/Guardian’sOccupation & Address :

15.Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D.No.
Dated:
Bank______________________
DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.
Place:
Date: Signature of the Applicant
DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
Other fees of my ward.
Plate :
Dated: Signature of Guardian/Parent
 APPLICATION FORM

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

GOWTHAMI COLLEGE OF NURSING

(Recognized by Govt. of T.S., Indian Nursing Council, T.S. Nursing Council & Affiliated to
K.N.R.U.H.S)

NOTE: Affix recent

i) Application is to be filled in by the candidate in Passport size
his/her own hand writing. Photograph
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected
iii) English Medium only

1. Name of the candidate in Full & : __________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name : __________________________

3. Mother’s Name : __________________________

4. Date of Birth and also in words

: __________________________

5. Annual Income of the Parent/Guardian : Rs.________________________

6. Address :

For Communication Permanent

Pin Code Pin Code:

7. Contact Landline & Cell No. i)

ii)

Other Alternate Number i)

ii)

8. Sex : Male/Female

9. Nationality : Indian

Contd…2
 -- 2 --

10. Religion : Hindu/Muslim/Christian

11. Social Status (Caste) : SC/ST/BC/OC, Sub-Group

12. Qualifying Examination Passed : Intermediate/Equivalent

13. Medium of Study in Qualifying Examination : Telugu/English

14. Residential Status : Local/Non-Local

15. Parent’s/Guardian’s Occupation & Address :

16. Student Aadhar Card Number :

17. Ration Card Number :

18. Bank Account Number :

Name :

Branch :

19. Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D. No.
Dated:
Bank______________________

DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.

Place:
Date: Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
Other fees of my ward.

Place:
Date: Signature of Guardian/Parent
 APPLICATION FORM
Last Date for submission of
Duly filled in application

Application No.______________________ Registration No.______________________

APPLICATION FOR ADMISSION INTO________________________________________COURSE

BLESS COLLEGE OF NURSING

(Recognized by Govt. of Andhra Pradesh)
Hyderabad.
ENGLISH MEDIUM
NOTE:
i) Application is to be filled in by the candidate in
his/her own hand writing.
ii)Application which is incomplete, wrongly filled or
received after the last date will be rejected

Affix recent
Passport size
Photograph

1. Name of the candidate in Full & :___________________________

Capital letter (as entered in SSC)

2. Father’s/Guardian’s Name :___________________________

3. Date of Birth and also in words :___________________________

4. Annual Income of the Parent/Guardian : Rs.________________________

5. Address :

For Communication Permanent

Pin Code Pin Code:

6. Contact Landline & Cell No.

Contd…2

-- 2 --
7. Sex : Male/Female

8. Nationality : Indian

9. Religion : Hindu/Muslim/Christian

10.Social Status (Caste) : SC/ST/BC/OC, Sub-Group

11.Examination Passed : Intermediate/Equivalent

12.Medium of Study in Qualifying Examination : Telugu/English

13.Residewntial Status : Local/Non-Local

14.Parent’s/Guardian’sOccupation & Address :

15.Details of (Previous) qualifying Examination : Inter CBSE ICSE

(Tick the appropriate Item)

a) School & College where last studied :

Name of the
Institution
Year of Study Class/Division Medium
a) Middle School
b) S.S.C.
c) Intermediate

b) Marks obtained in Intermediate

Telugu English Group Subjects Total

16. Particulars of Payment of Fee : Rs.____________________

D.D.No.
Dated:
Bank______________________
DECLARATION BY THE APPLICANT

I declare that the particulars stated above are correct. I solemnly affirm that, if
admitted, I will abide by the rules and regulations of the Institution.
Place:
Date: Signature of the Applicant
DECLARATION BY THE PARENT/GUARDIAN

I obey the rules and regulations of the School and the Principal may take any
action on my son/daughter if his/her conduct does not confirm to the disciplinary code of
the Institution/Hostel. I will be held personally responsible for payment of School fee &
Other fees of my ward.
Plate :
Dated: Signature of Guardian/Parent