Application for Online Admission

Government of Kerala

DEPARTMENT OF VOCATIONAL HIGHER SECONDARY EDUCATION APPLICATION FOR ADMISSION TO VHS COURSES

2012- 13

Read the instructions carefully before filling up the details Fill up the details in English using CAPITAL letters Submit the filled application to Nearest VHS School

1. Application No

( For office use)

2. Name of the Applicant

ADMISSION 2012

3. Date of Birth
Date

4. Age
as on 1/6/2012

5. Gender
M F

6. Religion

Month

Year

7.Caste

8 (i)

Category

8 (ii) Whether belongs to OEC

Yes No

9. Details of Qualifying Examination

Name of Examination

Scheme Code

Register No

Month

Year

No.of chances

VHSE

Name of School

10 (i) Whether completed/ Passed VHS course or equivalent Examination

Yes No

10 (ii) If yes, Name of Exam 11. Name of Parent/ Guardian

10 (iii) Branch
If VHSE

12. Address for Communication

Pincode 13. Telephone No. with STD Code 14. Mobile phone No.

15. E mail address

Department of Vocational Higher Secondary Education, Kerala

Application for Online Admission

16. Place of Residence

State code

District code

Taluk code

Local body

17. Eligibility for Bonus point

Dependent of Jawan Killed in action Dependent of Jawan in Service / Ex service NCC/ Scout/ Guide Swimming knowledge

18 (i) Eligibility for Special Reservation

Differently abled OEC

18 (ii) Special School Reservation

Deaf/Dumb

Sports

Children of Fishermen

18 (iii) Reservation for Linguistic minority 19. Achievements in Sports

International National No of events

Yes

No

18 (iv) If yes, Language

Tamil Kannada

State No of events No of events Ist place

District II Place III Place Participation

ADMISSION 2012

No of events

20. Achievements in Kerala School Kalolsavam

State No of Items No of Items A Grade District B Grade C Grade Participation

21.Whether qualified in the National/State lev el Talent Search Examination?

Yes No

22.Details of participation in co-curricular activities

Activity A B C D E Activity A B C D E

VHSE

State Science fair State Social Science fair Red cross activities

State Maths fair State IT fest State Work Experience fair

23. Whether the member of School Club/Clubs

Philately Club

Science Club

Red Cross

Debating Club

Environment Club

Oratory Club

Forestry Club

IT Club

Maths Club

Literary Contribution in School magazine

Literary Contribution in Periodicals

Scouts & Guides (But not awarded Rashtrapathi Puraskar or Rajya Puraskar)

24 Marks /Grades obtained in the

No Subject Grade/Mark awarded

Qualifying Examinations.
Maximum marks No Subject Grade/Mark awarded Maximum marks

1 2 3 4 5 6 7

8 9 10 11 12 13 14

Department of Vocational Higher Secondary Education, Kerala

Application for Online Admission

25. School-Subject Combination(s) in the order of preference
Preference No School Code Course Code Preference No School Code Course Code

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20 DECLARATION

ADMISSION 2012

I do hereby declare that all the information furnished above are correct. I know that any false information given in the application form will result in the cancellation of my candidature.

Place: Date : Name and Signature of Parent /Guardian Name and Signature of Applica nt

VHSE

ACKNOWLEDGEMENT
Received the duly filled application from Mr/ Miss ......................................................

(Application No. ....................), and entered as Sl. No. .............of application register of the School.

Place : Date : School Seal Signature of Principal

Department of Vocational Higher Secondary Education, Kerala