PROVISIONAL APPLICATION FOR ADMISSION

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Bhoganahalli, Bellandur Post,

560103, India.New Horizon College of Engineering,124/2,

Bangalore

Behind

PROVOIDING STRONG FOUNDATION

SL.No.______ Class ………………………………. Year ……………………………… 1.Name of the pupil _____________________________________________________________________ (Full name in block letters) (FIRST NAME) (MIDDLE NAME) (LAST NAME) 2. Date of Birth /Age as on 1st June 20__ __ Age____ Yrs_____Months 3.Nationality /Religion _____________________________/______________________________ 4. Category

5. Mother Tongue /Gender _________________________________________________ M F 6. a) Class last attended _______________________________________________________ b)Second Language Opting (Only for UKG) I Lang : English II Lang:Hindi Kannada 7. Language which the child can speak: 1. 2. 3. 8.Name of the Parent: ____________________________________________________________

9. Residential Address: ____________________________________________________________

____________________________________________________________

____________________________________________________________

10. Name and Std. of sisters & brothers Name :________________________________Std:_________ Sec:______ Studying in our school (not cousins):

Name: _______________________________ Std:_________ Sec:________

11. Are you a New Horizon Staff member? Yes/No Name: ________________________ Institute: ______________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Tear along dotted line - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ACKNOWLEDGEMENT(To be retained by the parent)

Received Registration Form of Miss/Master _____________________________________________S/o / D/o

________________________________for admission in class ________________ Parents are requested to bring the child on

_________________at _______________ for further discussion.

Date: _______________________ PRO

SC ST CAT 1 II A II B III A III B

General

Others Specify

XX

D D M M Y E A R

12. PARENT’S INFORMATION FATHER / GAURDIAN MOTHER Name: _____________________________ _____________________________

Educational Qualification _____________________________ _____________________________ Occupation Name of the company

_____________________________ _____________________________

(Central /State / Public Sector/ Pvt. Sector/ Self Employed)

_____________________________ _____________________________

Designation _____________________________ _____________________________

Transferable / Non-Transferable _____________________________ ______________________________

Office Name Address& Phone _____________________________ _____________________________

_____________________________ _____________________________

_____________________________ _____________________________

13. Phone No. Mob(Father) : __________________ Mob(Mother): _________________ -E mail (Father): _____________________________________________________

E-mail (Mother): ____________________________________________________

14. Annual Family Income: __________________________________________________________________ 15. In an effort to understand your child better, please mention (in detail) regarding

* Your child as a student: ____________________________________________________________

* Any learning disabilities: ____________________________________________________________

* Reasons for your interest to admit your child in our school ____________________________________________________________

16. Do you need Day Care facility for your child? Yes No 17. Do you need School Bus facility for your child? Yes No Note :

1. FEES ONCE PAID WILL NOT BE REFUNDED UNDER ANY CIRCUMSTANCES. 2. Registration DOES NOT ENSURE admission.

I declare that the above-mentioned details are correct and request that the applicant be admitted to class ____________ I agree to abide by the rules and regulations of the school. Date:_______________ Parent’s / Guardian’s Signature DOCUMENTS TO BE ENCLOSED WITH THE FORM 1. Passport size photograph 2. Copy of Birth certificate 3. Copy of Caste certificate if applicable 4. Copy of the child’s Aadhar. FOR OFFICE USE ONLY 1. Birth Certificate 2. Caste Certificate 3.Other relevant information

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Tear along dotted line - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - XX