S. R.

Education Centre
Affiliated to ICSE/ISC Board (New Delhi) Affiliation No. – UP338
PROVISIONAL ADMISSION FORM, CLASS – XI (2024 – 2025)
➢ Note: Please fill the form carefully. Any change in Name/ Surname/
Date of Birth / Spelling will not be allowed after submitting this form.
➢ Fill the Form in CAPITAL LETTERS

1. Name : __________________________ Scholar No : _______________________

DOB (As per Aadhar Card/ As per the Birth Certificate): ___________________

Aadhar No. of the Student: ____________________________________________

Religion: ________________________ Caste: ____________________________

Category: General SC. ST. OBC OTHER

Father’s Name: _________________________________ Mobile: ___________________________

Mother’s Name: ________________________________ Mobile: ___________________________

2. Address : ________________________________________________________________________

________________________________________________________________________

3. Subjects Offered:
Science Group – A Commerce Group – B
1) English 1) English
2) Hindi 2) Hindi
3) Computer / Physical Education 3) Computer / Physical Education
4) Physics 4) Commerce
5) Chemistry 5) Economics
6) Maths/ Bio 6) Accounts

Subjects Selected:
1) ______________________ 2) ____________________ 3) _____________________

4) ______________________ 5) ____________________ 6) _____________________

4. Signatures : -

Father: Mother:

--------------------------------------------------------- For Office Use ------------------------------------------------------------

➢ Verified by Class Teacher : __________________________

➢ Verified by School Office : __________________________

➢ Verified by Principal : __________________________