4
* Marked with (*) are mandatory. 40 * Don't refresh the page during filling form. * (Your application will be registred only after the payment of application money to United Bank of India.) Payment & Course Details Bank Transaction No. : AA36311 Date of Payment : 02/05/2015 Amount : 600 Course : I.A. Session : 15-17 Stream : NA Upload Photo Photo Size (3x3 cm or 85x85 px) only in .jpg, .gif, .png format (Photo Upload is Mandatory) SELECT PHOTO : No file chosen Choose File Browse & Click here to Upload Photo Personal Details * Required fields (All details as per in your Matriculation Certificate) *Applicant Name : *Applicant Name Hindi : Type your name in English and press spacebar. *Father's Guardian's Name : *Mother's Name : *Marks of Identification Aadhaar No (UID) : *Date of Birth : (dd-MM-yyyy) *Birth Place : *Applicant State : STATE *Marital Status : MARITAL STATUS *Category : CATEGORY *Sub Category : SUB-CATEGORY *Gender : GENDER *Blood Group : BLOOD GROUP *Religion : SELECT RELIGION Phone (LL) : *Mobile : Email : *Economic Status : ECONOMIC STATUS

Intermediate Application Form

Embed Size (px)

DESCRIPTION

AI

Citation preview

Page 1: Intermediate Application Form

* Marked with (*) are mandatory. 40

* Don't refresh the page during fi l l ing form.

* (Your appl ication wi l l be regis tred only after the payment of appl ication money to United Bank of India .)

Payment & CourseDetails

Bank TransactionNo.

: AA36311 Date of Payment : 02/05/2015 Amount : 600

Course : I.A. Session : 15-17 Stream : NA

Upload Photo Photo Size (3x3 cm or 85x85 px) only in .jpg, .gif, .png format (Photo Upload is Mandatory)

SELECT PHOTO : No file chosenChoose File

Browse & Clickhere to UploadPhoto

Personal Details * Required fields (All details as per in your Matriculation Certificate)

*Applicant Name :

*Applicant Name Hindi : Type your name in English

and press spacebar.

*Father's Guardian'sName

:

*Mother's Name :

*Marks ofIdentification

Aadhaar No (UID) :

*Date of Birth : (dd-MM-yyyy)

*Birth Place :

*Applicant State : STATE

*Marital Status : MARITAL STATUS

*Category : CATEGORY

*Sub Category : SUB-CATEGORY

*Gender : GENDER

*Blood Group : BLOOD GROUP

*Religion : SELECT RELIGION

Phone (LL) :

*Mobile :

Email :

*Economic Status : ECONOMIC STATUS

Page 2: Intermediate Application Form

*Mother Tongue :

*Locality : LOCALITY

*Nationality : INDIAN

Parents/GuardianDetails

* Optional (Provide Only Correct Information if Applicable)

Father's/Guardian's Details

Is yourFather anold studentof thisCollege

: NOIs he amember ofAROX

: NO Occupation : OCCUPATION

Designation : Phone No : Mobile :

Email : Qualification :

Mother's Details

Is yourMother anold studentof thisCollege

: NOIs she amember ofAROX

: NO Occupation : OCCUPATION

Designation : Phone No : Mobile :

Email : Qualification :

Applicant Address * Provide Only Correct Information.

Applicant Permanent Address Applicant Correspondence Address

*PermanentAddress

:

*City/District

:

*State : STATE

*Pin/ZipCode

:

Click If Both Address Is Same.

CorrespondenceAddress

:

City/District :

State : STATE

Pin/Zip Code :

Select Subject * All fields are mandatory in this section (Read carefully instructions in the Prospectus)

INTERMEDIATE (ARTS) FIRST YEARCOMPULSORY PAPER-I

CORE LANGUAGE*: SELECT

ELECTIVE LANGUAGES(ANY ONE)*

: SELECT

OPTIONAL PAPER-I* : SELECT

OPTIONAL PAPER-II* :ECONOMICS

OPTIONAL PAPER-III* :POLITICAL SCIENCE

ADDITIONAL SUBJECTS(ANY ONE)*

: SELECT

* This field is required

* This field is required

* This field is required

Page 3: Intermediate Application Form

Academic Record * All fields are mandatory in this section

PASSED MATRIC/ICSC/CBSE DETAILS

EXAM NAME : SELECT PASSING YEAR : SELECT

BOARD : BOARD DIVISION/GRADE :

NAME OFSCHOOL

: STATE : STATE

REGISTRATIONNO

: MEDIUM : SELECT

Other Details * Provide only correct information.

1 : If Physically Challenged. : NO

2 :If yes specify the detais parts ofphysical disabilities &percentage

:

3 :Son/Daughter of Ex-servicemen.

NO

4 :Conveyance if any, used tocome college.

: NOIf yes Keep always driving licence &parking pass with you.

5 :Other Examination/Course orstudies taken.

:

6 : Extra Activities :

7 : Skill Level : NO

Undertaking

1 :I hereby to abide by the College and Jharkhand Intermediate Education Council Rules regardingattendance, viz., that if my attendance is found to be unsatisfactory, I shall not bepromoted/permitted to next higher classes/Examination.

2 :I am aware of the Rules and Laws regarding ragging. Ragging is strictly prohibited.It is apunishable offence.

3 :I hereby accept the College Privacy that students with serious complaints of indisciplineagainst them, will not be readmitted/promoted to the next higher class.

4 : I am ready to accept the college policy on leave/college functions/eductional activities.

5 :A Student will not be granted promotion unless:i. He/She has attended at least 75% of the lectures and 75% of Practicals.ii. His/Her performance at the semester examination is satisfactory.

I declare that all the above mentioned information is correct & true and I will abide by allRules and Regulations of the College and accept the decision of the Principal in all mattersas final.

Submit

Page 4: Intermediate Application Form

Copyright © 2014 - All Rights Reserved - St. Xavier's College, Ranchi Mail us for any help:: [email protected]