Rs.

10/-
THE IIS UNIVERSITY
(Deemed University)

INTERNATIONAL COLLEGE FOR GIRLS, JAIPUR

REQUEST FORM FOR RESIDENTIAL FACILITIES
2010-2011
NAME OF THE APPLICANT : __________________________________________________________

CLASS AND FACULTY : __________________________________________________________

(SEEKING ADMISSION IN)

SCHOOL/COLLEGE : __________________________________________________________
(LAST ATTENDED)

DATE OF BIRTH : __________________________________________________________

MAILING ADDRESS : __________________________________________________________

______________________________PIN_________________________
__________________________________________________________

PERMANENT ADDRESS : __________________________________________________________

______________________________PIN_________________________
__________________________________________________________

FATHER’S NAME : __________________________________________________________

PROFESSION : __________________________________________________________
PHONE NO. : (Off.) _________________________ (Res.)_______________________
MOBILE NO. : __________________________________________________________

LOCAL GUARDIAN

NAME : __________________________________________________________

ADDRESS : __________________________________________________________

__________________________________________________________

________________________________PIN_______________________

PHONE NO. : _____________________________ Mobile No. ___________________

EXAMINATION PASSED : ___________________________ PERCENTAGE __________________

(Attach Marksheet)

SIGNATURE OF DATED SIGNATURE OF

PARENT/GUARDIAN CANDIDATE