ALPHA INTERNATIONAL ACADEMY

Kataria Farm, Sirsi Road, JAIPUR

CBSE Registration Form XI & XII (Session 2021-22)
Note: The data mentioned in the form is for CBSE use. Kindly make sure it should be filled strictly as per school -
records especially Student’s Name, Parents’ Name & Date of birth. Attach photocopy of last class attended Report -
Card. If any kind of correction is required in data, please meet in school office. Once your ward is registered in
CBSE, modification in record will not be possible in any case, please be very careful in filling the details.
It is mandatory to fill all the details. Not a single column should be left blank. Submit two recent photographs with your
name & date printed on it.

SR. No.: …………………………………... Class: ……………………..

Photo
Registration No.: ……………………..… (For class – XII only) Faculty: …………………...
(Black & White)
Registration Fee: ………………………...

1. Student’s Name (in Block letters)

2. Mother’s Name

3. Father’s Name

4. Date of Birth D D M M Y Y Y Y

5. Date of Birth
(In words)

6. Subjects: 1. English Core 2………………………… 3…………………………….. 4………………………………

7. Optional Subject: 1. Physical Education / IP / Yoga / FN & D ……………………………………………………….
8. Category: General/SC/ST/OBC ………………………………..
9. Do you belong to minority section: Yes/No ………………….....
10. Handicapped: Yes/ No …………… If yes, kind of disability ……………………………………………………
(If yes, Attach Medical Certificate)
11. Annual Income: Father’s Income: ………………………… Mother’s Income: ………………………………
12. Whether only Child in the family; Yes/No...........................
13. For XI class only: Details of Secondary Exam Passed
1. Roll No.: ……………… 2. Year: ……………... 3. Exam Name: …………………. 4. Board: ……………
14. Filling in clear and readable handwriting is mandatory:
1. Email (student/parent): ……………………………………………………………….
2. Aadhar No of student: ………………………………………………………………..
3. Mobile No.: Father ………………………..… Mother ………………………………

Student Signature
Declaration by the Parent:
I hereby declare that all the information given by me in this application is true and correct to the best of my
knowledge and belief.

Date: Parent/Guardian’s Signature