Jalipacantt.kvs.ac.in



के न्द्रीयविद्यालय जालिपा केंट बाड़मेर

JAISALMER ROAD, BARMER – 344001 KENDRIYA VIDYALAYA JALIPA CANTT BARMER

|E-mail:kvjalipa@ |जैसलमेर रोड बाड़मेर-344001 |

| |ई - मेल: kvjalipa@ |

| | | | |

|Website:- | |

| |िेबसाइट:- jalipacantt.kvs.ac.in |

|Phone: 9119150999 | |

| | |फोन: 9119150999 | |

| | | | | | |

Fax 02982-220429

फै क्स 02982-220429

CBSE Affiliation No: 1700022 School Code : 14143

Application for Admission to class XI Session 2020-21

1. Name of the student (in Block Letter) …………………………..

2. Admission Number for Student of KV JALIPA CNATT.BARMER…………………..

3. Name of father ……………………..occupation………………..

4. Name of mother…………………….occupation………………..

5. Date of Birth(DD/MM/YYYY) ………………………………………………………..

6. Gender (Male / Female)…………………………………………

7. Caste (SC / ST/OBC-NCL)……………………………………

8. Category to which the Parent belong to Defense / Central Govt. /

Autonomous Body & other (I/II/III/IV/V) & office address…….

…………………………………………………………………….

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9. Residential Address (With Proof) ……………………………………………………………………….

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10. Telephone No. / Mobile No. 1.………………………2.……………..

MAIL ID----……………………………………………..

11. Name of the school from where Class X passed……………………

12. Admission seeking in (Science Stream / Humanities(Arts) Stream )in

class XI………………………………………………………..

13. For CBSE based result in Class X as per mentioned below –

|Sr. |Total |Total |Aggregate |Percentage |Percentage of |

|No. |Overall |Marks |percentage |of marks |Marks in |

| |Marks |obtained |of marks |in Maths |Maths+Science |

| | | | | | |

14. For Non-CBSE based Result in class X as per mentioned below –

|Sr. |Total |Total |Aggregate |Percentage |Percentage of |

|No. |Overall |Marks |percentage |of marks |Marks in |

| |Marks |obtained |of marks |in Maths |Maths+Science |

| | | | | | |

15. Name of Board & Name of school ……………………………….

a) Achievements in Sports & Games ( if so, please attached photo copy )…………………………………………………………

1. Participation at SGFI or equivalent level……………………….

2. Participation at KVS National / State level ……………………..

3. Participation at KVS Regional / District level…………………...

b) Details of NCC(if so , please attached photo copy)

c) Details of Scouting / Guiding (if so , please attached photo

copy)………………………………………………………………

1. Rashtrapati Purskar award certificate……………………………..

2. Rajya Purshkar award certificate with 07 proficiency badges………………………………………………………………

3. Tritiya Sopan Certificate with 05 proficiency badges………………………………………………………………

Participation in at least 10 days Adventure Activities ( if so , please attached photo copy )……………

17. Combination Available under Science Stream : -

A) ENG./PHYSICS/CHEMISTRY/MATHS/HINDI

B) ENG./PHYSICS/CHEMISTRY/MATHS/COMP. SC.

C) ENG./PHYSICS/CHEMISTRY/BIOLOGY/HINDI

bination available under Humanities(Arts) Stream : -

A) ENG./HINDI/HISTORY/GEOGRAPHY/ECONOMICS

B) ENG./HINDI/HISTORY/GEOGRAPHY/POL.SCI.

Mentioned your combination as per above combination in Science Stream/ Humanities(Arts) Stream

CHOICE : 1

CHOICE : 2

CHOICE : 3

20. If not admitted in Science , I am ready to get admission in Humanities Stream (YES/NO)

Note : -

1. Enclose attested Xerox copy of marks sheet of class X & caste certificate SC / ST / OBC-NCL, if belong.

2. Enclose attested Xerox copy of the KV TC / Leaving Certificate of Previous School, if other than KV JALIPA .

Date : ……………….

Signature of Parent / Guardian

Signature of Student.

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