UTTARAKHAND STATE OPEN SCHOOL

Dayal Enclave 41 Jamalpur Haridwar Uttarakhand 249407

Email ID : usosdehradun@gmail.com

INTERMEDIATE ADMISSION FORM

Name of student’s:

Father’s Name:

Mother’s Name :

Date of Birth:

Examination :

Name of the AI center:

Subject Taken:

Name of Student:

(Signature of Student)
(Signature of director) with office seal

FOR OFFICE USE ONLY

Certified that S/O,D/O

Eligible for admission in I received admission fee sum

Of Rs. By DD No. Cash on dated

Sig of controller regional center (Signature of cashier)

with seal
 UTTARAKHAND STATE OPEN SCHOOL
Dayal Enclave 41 Jamalpur Haridwar Uttarakhand 249407
Email ID : usosdehradun@gmail.com

SELF DECLARATION

I……………………………………………………D/S/O/………………………………..

R/O………………………………………………………………………………………….

F/O…………………………………………………………………………………………

Do hereby solemnly affirm and declare as under:

1) That I am the permanent resident of the above said address.

2) That the date of birth of my child is ……………………………………………..

3) That he / she wants apper in course……………for the year …………………

From Uttarakhand State Open School

Through………………………………………………………………………………

That I fully understand of the rules, regulations and legal status of the

Uttarakhand State Open School.

4) .

Deponent

Declaration

I solemnly declare that the particulars given above are correct to the best of my knowledge
I also understand that if the information provided by me in the from is incorrect, incomplete or false, my
application will be rejected upon detection at any stage.

Deponent