Ref. No.

School, Burdwan
St. Xavier’s School,
Paste Passport
Application Form for Entrance into Class 11 ISC 2019 – 2020
size coloured
SCIENCE ◘ PHOTO
COMMERCE ◘
HUMANITIES ◘
(Indicate your Choice)

Pupil’s Name :
[Full name : (SURNAME first ) one letter per block with space between each name, as per Admission Card]

Date of Birth : (day, month, year) Boy / Girl

Community that he / she belongs to : SC ST OBC GENERAL (tick whichever is applicable)
Index No. / Regd. No. : UID :

Board / Council :

School :
Marks obtained in Board / Council Examination :

For all applicants : Total : / Percentage : Mathematics :

Father’s Name :
(Full name in block letters)

Father’s Occupation :

(Full designation with address & Phone Number)

Father’s Monthly Income :

(Supported by pay slip / employer’s certificate. If self employed, income tax returns)

Mother’s Name :
(Full name in block letters)

Mother’s Occupation :
(Full designation with address & Phone Number)

Mother’s Monthly Income :

(Supported by pay slip / employer’s certificate)

Residential Address :

Phone Number : Mobile Number :

Date :

( Signature of Father ) ( Signature of Mother )

(See overleaf for Rules & Regulations)

CHOICE OF STREAM AND SUBJECTS :

SCIENCE STREAM COMMERCE STREAM HUMANITIES

ENGLISH ENGLISH ENGLISH

MATHEMATICS MATHEMATICS SOCIOLOGY □ COMPUTER SC. □
PHYSICS ACCOUNTS POLITICAL SCIENCE
CHEMISTRY ECONOMICS HISTORY □ GEOGRAPHY □
BIOLOGY □ COMMERCE □ ECONOMICS
OR OR BENGALI □
BIOTECHNOLOGY □ COMPUTER SC. □ OR
COMPUTER SC HINDI □
BENGALI □
OR
HINDI □

(1) Opt for only one stream and indicate with a tick mark, the electives you wish to study.

(2) Community Service and SUPW are mandatory for all.

(3) The Principal reserves the right to determine the final choice of stream and subject.

(4) Attendance is obligatory in the School. Students are expected to attend classes everyday without fail.

Statement of Intent

I, …………………………………………….undertake to abide by the norms and spirit of the school and to participate in it’s
programmes of personal growth and outreach.

Date: ______________ Signature of Applicant: ____________________ Signature of Guardian: ________________

NAME : ___________________________

Principal
10.05.2019