JEEWAN PUBLIC SCHOOL
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STUDENT REGISTRATION FORM
(All "
*
" marked fields are MANDATORY, mention "N.A." if not applicable.)
Sibling Detail (only real brother / sister currently studying in this school)
Sibling :
Admission No. :
Sibling Name :
Sibling Class :
Application Form Information
Candidate Photo :
Class Applied for :
--Select Class--
NUR (2022-23)
LKG (2022-23)
UKG (2022-23)
I (2022-23)
II (2022-23)
III (2022-23)
IV (2022-23)
V (2022-23)
VI (2022-23)
VII (2022-23)
VIII (2022-23)
IX (2022-23)
X (2022-23)
XI (2022-23)
XII (2022-23)
Candidate's Personal Information
First Name :
Middle Name :
Last Name :
Date of Birth (dd-mm-yyyy):
D.O.B. Certificate No. :
Email (for communication) :
Aadhaar No :
Nationality :
Mobile No.
(for communication) :
Landline No. :
Gender :
--Select Gender--
Male
Female
Address :
City :
State :
Country :
PIN :
State of Domicile :
Category :
--Select Category--
EWS
GENERAL
OBC
SC/ST
Religion :
--Select Religion--
Hindu
Muslim
Sikh
Christian
Buddhist
Jainism
Others
Any medical condition
requiring School's special
attention :
Remarks :
Corresponding Relative :
--Select Corresponding Relative--
FATHER
MOTHER
School Transport Required :
Preference - 1:
--Select Bus Stop--
MATHIYA BOHAT
PHULWAR
BATHNAHIYA
BISUNPURWA
DUHO SUHO
HIRAMANI
PURUSHOTAM PUR
SEEHOROWA
SEMRAHIYA
SEMRAHIYA
VISHNU PURWA
BAKHTAURA
BATHUAHIYA
BELA
BHAWANIPUR
CHAINPUR
GAMHARIYA
JEETPUR
KHAIRWA
KHAIRWA
LAKSHMIPUR
MAHUVAWA
NARAYAN CHAWK
PAKDIYA
PNBLAKHAURA
BATHUAHIYA
BELA
BHAWANIPUR
CHAINPUR
GAMHARIYA
KHAIRWA
LAKSHMIPUR
MAHUVAWA
PAKDIYA
GONAHI
HARDIYA
CHAURADANO
ISLAM CHAWK
MAHUWA -BHAWANIPUR
MURLI
PIPRA
SREE PUR
NIMOIYA
BIRTI
DHOOM NAGAR
GOLA PAKADIYA
INARWA
JAGIRANHA
JAINAGAR
JUAPHAR
MAZIRWA
AJGARWA
BARWA
DOSTIYA
LAKHAURA
NAURANGIYA
BASWARIYA
KHODA
KATAHRIYA
NARKATIYA
PATHAN-TOLI
KATGENWA
BHELWA
DHARHARI
GULARIYA
JHITKAIYA
MATHIYA/GONAHI
TINKONI
SUKHLAHIYA
TINKONI
MURLI
PURUSHOTTAMPUR
PAKADIYA EXTENDED
HIRAMANI
GAMHARIYA KALAN
Preference - 2:
--Select Bus Stop--
PHULWAR
BATHNAHIYA
BISUNPURWA
DUHO SUHO
HIRAMANI
PURUSHOTAM PUR
SEEHOROWA
SEMRAHIYA
SEMRAHIYA
VISHNU PURWA
BAKHTAURA
BATHUAHIYA
BELA
BHAWANIPUR
CHAINPUR
GAMHARIYA
JEETPUR
KHAIRWA
KHAIRWA
LAKSHMIPUR
MAHUVAWA
NARAYAN CHAWK
PAKDIYA
PNBLAKHAURA
BATHUAHIYA
BELA
BHAWANIPUR
CHAINPUR
GAMHARIYA
KHAIRWA
LAKSHMIPUR
MAHUVAWA
PAKDIYA
GONAHI
HARDIYA
CHAURADANO
ISLAM CHAWK
MAHUWA -BHAWANIPUR
MURLI
PIPRA
SREE PUR
NIMOIYA
BIRTI
DHOOM NAGAR
GOLA PAKADIYA
INARWA
JAGIRANHA
JAINAGAR
JUAPHAR
MAZIRWA
AJGARWA
BARWA
DOSTIYA
LAKHAURA
NAURANGIYA
BASWARIYA
KHODA
KATAHRIYA
NARKATIYA
PATHAN-TOLI
KATGENWA
BHELWA
DHARHARI
GULARIYA
JHITKAIYA
MATHIYA/GONAHI
TINKONI
SUKHLAHIYA
TINKONI
MURLI
PURUSHOTTAMPUR
PAKADIYA EXTENDED
HIRAMANI
GAMHARIYA KALAN
Father's Detail
Father Photo :
First Name :
Middle Name :
Last Name :
Email Id :
Mobile Number :
Landline Number :
Occupation :
--Select Occupation--
Business
Others
Service
Organization :
Office Address :
Qualification :
--Select Qualification--
Any Other
B.Ed
CTET
Graduation
High School/10th
Inter/+2
M.Ed.
M.Phil
Ph.D
Post Graduation
Designation :
Annual Income (In Rs):
Mother's Detail
Mother Photo :
First Name :
Middle Name :
Last Name :
Email Id :
Mobile Number :
Landline Number :
Occupation :
--Select Occupation--
Business
Others
Service
Organization :
Office Address :
Qualification :
--Select Qualification--
Any Other
B.Ed
CTET
Graduation
High School/10th
Inter/+2
M.Ed.
M.Phil
Ph.D
Post Graduation
Designation :
Annual Income (In Rupees):
No. of Son(s) :
No. of Daughter(s) :
Additional Information
Present Class :
Present School Name :
Board Name :
--Select Board Name--
CBSE BOARD
UPSC
Source of Information :
--Select Source of Info.--
Any other
Hoarding
Newspaper
RAHUL Z CAMPAIGNING
SANJAY KUMAR Z CAMPAIGNING
Word of mouth
Disclaimer
I/We understand that if any of the above information is found to be incorrect or false, my/our ward shall be automatically debarred from the selection / admission process without any correspondence in this regard. I/we also understand that the application / registration / shortlisting does not guarantee admission to my ward. I/We accept the process of admission undertaken by the school and I/we will abide by the decision taken by the school authorities. I have read all guidelines and information provided on the school website and promise to abide by the rules formulated by the school. I also understand and agree that in all matters pertaining to admission, the decision of the school authorities will be final and binding.
It is mandatory to read the
Terms and Conditions for Online Payment of Registration Fee
before proceeding to make payment. Clicking on "Agree" will imply your acceptance of these
Terms and Conditions
.
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