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Def ence secto r, Po- Kampa, Dist 24 PGs ( N), Pin - 74 3193

Ad mission in class XI
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Option form : 2020-21
(Only for KV Stude nts)
Name of the l<V w here admission sought· .. .l<.V..,N .O... ·~-:J..... KA.N.C.H.R-B.P..B..RB......

Nam e of Student : ....M.A.N.t'\.1~1.r ......:c.B.s........................................ .

Name of th~:{_i_d yalaya where studied class X:... l~Y..N.0..::1 .... K.B.N.~.K.RA.-P.A..IZA
DETAILS MOTH ER'S DETAILS FATHER' S DETAILS
Name S 1/\J ~ s JOY D V bP.. c
Occu patio n / Ho ~RM y
I_Department
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Class X Details Marks ( Attach gra de sheet/ Marks sheet)
Previous
-- - ·---· - Rem ark
Adm . No. Board Ma rks obtain ed in Gra nd tot al Tota l% in
class and Ro ll No. in 5 5 subjects,
Maths Science
section subj ects, excluding
' excl uding IT IT
X ---- ~ II o 22. 1214016"2 <21 57 335 ,.(;"( y,

St ,eam ( please tick your stream and option)

rc:;--i----
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01
-- - - -----r,- ·-- --- -·---- -· --··--- --·----·
Strea m _
, Sc en ce
1 Subject (Compulsory) _ ___ _
1 Phys ics 2 Chemistry 3.
~~~hs
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==---
--- AddiHo_"a_l~ -::-- 7

I English 2 Biology
3. Com p. Sc.T I/ Hindi D
(Please t ick any 2 out of
02 I Commerce 1. Acct. 2. B. St. 3. Economics- - ~1.-H-in-di CJj 1PEf7 ·-- PH & E
'
4. English Maths D (Additional)

. 03
...___ _ _ _ _ _ _ _ _ _ _ _ _ ·- - -- - ___
' Humanities 1. Eng. 2. Hindi 3 . Geo 4 .
(Please tick an~y _
1. Economics 0
o_ne-')- - - - 1 - - - - - - - - l
I PH&E

[j _ _ ____ - ·
History
--·---- - - - -- ... _ __ (~~ase tick an-'--
y _o
1. Whether belongs to SC/ ST/ PH ( At tach photo copy)---------NA-------------------
__ne
Pol. Sc.
--')- - - ' - - -·- --- -
0 (Addit ional)

2. Sports & Games :- Part icipat ion at SGFI or equivalent level, Partici pation at KVS National/ State level.
Participatio n at KVS Regional/ District Level, (Attach photo copy ) if any.
3. NCC-( 'A' certifica te and participa t ion in Republic/PM Rally, 'A' certificat e and best Cadet in Distt/ State
\eve! /'A' certificate (Attach photo copy) if any.
4. Scouting/ Guiding - Rashtra pati Puraskar award certifi cate, Rajya Pu ruskar award cert ificate with 07
proficiency badges. (Attach photo copy) if any.
s. Adventure Activities ( Participation at least One 10 days adventure activity) . (Atta ch photo copy) if
any.

Signature of Student.. ....... M.0.-:0.~~\.'.:D.~ .............. Date .. 2 .Q..,.. 9.7,..,.. 2-0 2 O

Signature of Father:.................... ~ ............................. Signature of Mother.£s0.f-h.~ ..~ ~
Signatu re of Admission 1/C ... .. .......... ............................. ..
Princi pal
Note :- 1 Ma re oot1on doe,not con fe r the right of asm1ss1on, bu t w ill be provided as pe• ru les.
 Ad mission in cla ss X I
Optio n form : 2020-2 1
(Only tor !<'/ Stu::;:;::~;
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Phone No --8-583210(;(,'2.... 95"(;t22 ::C ~5"0
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- - -- - - - I =---- - -- -- -
- as:; X De~!ls i'./lar~s ( .u.ttach grade sheet/ Mar~ sr-;ee:) - -
Previous /"'dm r·Jo Board r.'iar!--s obtc~ ec-;- - G~c-d :0:2 T:;:2. ~~ ::- "e-~2~~
clc1s~ and Rol l No. in S 5 su:~e::ts_.
section Maths Science
subjects, exdudi~g
1 excluding IT t IT
I X ---- p,,. 11 022- 112 140162 i, 57 335 I .[;"{ •

_it;,-;;r,- ( :Jlcase t c1: vour s: reari ard oot ·on)

S' J • S:r 0 ar, - - -S~bi~c:t(Co~oJlsc~) - Op· or
----- - - - -·- -
01 Sr i:: rcr 1 ':J ~/S cc 2 c~ eT s:") 3 1 Va:" s
Ergl1sr 2 B o!ogy
3 Como Sc _, 7 r j 1 -~
(Please tick a"\ 2 out of
/ 02 Commcrcy 1 Acct. 2 B St 3 Econ-om
-1c-s- ~l -H1nd1 c:]TIP0 _ _____P_H_&_E_ _
4 Engl sh Maths D
(Addit!onal)
I
03
.__ .,___
Humanities 1. Eng 2. Hindi 3 Geo 4
__ __
Economics
I (Please tick any one) _
11
_ __ _ _ __
PHS:.E O /
I History Pol Sc O
(Add1t1onal)
____ _ _ _ __ ~ aset1c~any one)._ ____,.___
1 Whether belongs to SC/ ST/ PH ( Attach photo copy)---------~ -----------------
2 Sports & Games Partic1pat1on at SGFI or eq uivalent level, Part1c1pation at KVSNational/ State level
Participation at KVS Regional/ Distri ct Level (Attach photo copy) if any
3 NCC-( 'A' certificate and participation in Republic/ PM Rally, 'A' certificate and best Cadet in Distt/ State
level/'A' cert1 f1cate (Attach photo copy ) if any
4 Scouting/ Gu iding - Rash l rapa t1Puraska r awa rd certificate, Rajya Puruskar award cert1f1catc wit h 07
proficiency badges (Attach photo copy) if any
S J\dventure Activities ( Participation at least One 10 days adventure activity) (Attach photo copv ) if
,111y .

Signat ure of Student... .....M.0-:0.!:'~1 .2>~.. ........ Date. 2 0..!..9 7..,..) 0 2 0

Signature of Father· .............. ~ - . ...... ..... ..... Signature of Mother.~ ~s.s-p.~.: -~.-~C' ~

Sign3turc o f Admission 1/C

Principal
r~oto 1 ·1;1il re optI0 I1uoesnot confer the rig ht of asri11Ss Ion but will be nrov1ded as per rule~
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