Admission Form - XI (Science) Student Details Student's Name* : Date of Birth* : Gender* : -- Select Gender -- Male Female Category* : -- Select Category -- General OBC SC ST Nationality* : -- Select Nationality -- Indian Other Religion* : -- Select Religion -- Hinduism Islam Christianity Sikhism Buddhism Other Aadhaar No* : Family & Guardian Father's Name* : Mother's Name* : Guardian's Name (If Father is not Alive) : Relationship : Contact Details Mobile No 1* : -- Select Relation -- Father Mother Brother Sister Uncle Grandfather Other Mobile No 2: -- Select Relation -- Father Mother Brother Sister Uncle Grandfather Other Village / House No, Streat Name* : Post Office* : Police Station* : District Name* : -- Select District Name -- Malda Murshidabad Uttar Dinajpur Dakshin Dinajpur Alipurduar Bankura Bardhaman Birbhum Cooch Behar Darjeeling Paschim Midnapore Purba Medinipur Hooghly Howrah Jalpaiguri Jhargram Kolkata Nadia North 24 Parganas South 24 Parganas Purulia Area PIN* : Admission Details Campus* : -- Select Campus -- Kaliachak (KCAK) Gazole (KCAG) Class* : -- Select Class -- Class XI Department* : -- Select Department -- Science I solemly declare that the particulars given above are true and correct to the best of my knowledge and belief. Submit
