15/3, Wyre Street, Wari

01814212747 | 01939965336
facebook.com/PencilsEduBD
pencil.institutebd@gmail.com

STUDENT ADMISSION FORM

Date
Name
PROGRAM
Birth Date AFTER SCHOOL
PRE O'LEVELS
Current Address
O' LEVELS
Permanent Address
Phone A' LEVELS
Email
Blood Group CURRICULUM
Father's Name Phone
Father's Blood-Group
Mother's Name Phone
Mother's Blood-Group
Local Guardian Phone
Blood Group

**Please fill in the relevant table

SELECTED SUBJECTS (O'LEVELS)

SELECTED SUBJECTS (A'LEVELS)

SELECTED SUBJECTS (PRE-O'LEVELS)

 15/3, Wyre Street, Wari
01814212747 | 01939965336
facebook.com/PencilsEduBD
pencil.institutebd@gmail.com

STUDENT ADMISSION FORM

SUBJECT PREFERENCES (SUBJECTS THAT INTEREST YOU)

**Please answer the questions below.

Previous School/Instituition:

Upcoming Session for Examination Appearance: (eg. January, 2024)

Rules and Regulations

1. The students must keep their phones on silent mode during class.
2. The students will be reported to their guardians if they are consecutively or/and frequently late.
3. A student who is continuously absent for more than two months will have to take re-admission.
4. The monthly fees must be cleared within the 10th of that month.
5. Students will be expelled if found to have used tobacco, drugs or alcohol within the premises.
6. The students will be reported to their guardians and the authorities if any weapon or object of
harm is found on the student.
7. Religious or political debates are discouraged within the premises.
8. Students are discouraged to litter both within and outside the premises.
9. Students are expected to recompense the institution, if they are responsible for the damage of
any institution property.
10. Students are expected to not use foul language within the premises.
11. Any form of bullying or ragging is strictly prohibited.
12. Students should be encouraged to treat others with kindness and respect, including classmates,
teachers, and staff.
13. Students are expected to resolve conflicts peacefully and should not engage in fighting or violent
behavior with fellow students.

Authority Signature Student's Signature Guardian's Signature