ADMISSION FORM (9th to 12th Class)

Registration No : ____________________________________________________

Class : 9th 10th 11th 12th

(In which you want to take admission)

Coaching Plan : Regular Residential

Student Name : ____________________________________________________

Father’s Name : ____________________________________________________

Mother’s Name : ____________________________________________________

Gender : Male Female

Date of Birth : ____________________________________________________

Category : ST SC OBC General PH Other

Nationality : ____________________________________________________

Permanent Address : ____________________________________________________

: ____________________________________________________

City : ______________________ District : ___________________

State : ______________________ Pin Code: ___________________

Mobile No : ____________________________________________________

Email : ____________________________________________________

Medium : Hindi English (If Other) _______________

Current Class : ____________________________________________________

Current Board : ____________________________________________________

Current School : ____________________________________________________

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How did you come to : News Magazine Friends Internet/website
Know about RS
Ex-Student Relatives Any Other Source

Are You an Old RS Student : Yes No

Father Occupation : Govt. Service Private Business Other

Yearly Income of Parents : Below 1 Lac 1 Lac-2 Lac 2-3 Lac Above 3 Lac

Have You Taken Coaching Past : Yes No

Why R.S. Academy : ______________________________________________________

__________________________________________________________________________________

Qualification Details

Class Board Year Aggregate

(%)
IX
X
XI
XII

……………………………………………… ………………………………………………
(Office Authority) Student Signature

Head Office Branch Office

Flat No.1, First Floor, Ring Road No.-1,
Opposite of CM House, Sheela Residency, Opp Filter Plant, Behind of Rawatpura Colony,
Civil Line, Raipur (C.G.), 492001 Bhatagoan, Raipur (C.G.)

Mob: 099813-11116, 099813-11118 Phone: 0771-4000252

Email: info@rsacademy.co.in, admission@rsacademy.co.in

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