CANTONMENT ENGLISH SCHOOL & COLLEGE CHATTOGRAM CANTONMENT
ADMISSION FORM
□ Defence □ Civil
Group: Science
Index No:
Desired class for admission: ... ... Section:... Class Roll: ……..
To be filled up by the office
1. Full Name (Block Letter):...
2. Date of Birth: ... Religion: ...Blood Group:...
Nationality: ... Sex: tick (√)
3. Father’s Name (Block Letter):...
Occupation: ... Designation/ Rank: ...
Unit/Organization: ... Location:...
Contact No: ... e-mail: ...
4. Mother’s Name (Block Letter):...
Occupation: ... Designation/ Rank: ...
Unit/Organization: ... Location:...
Contact No: ... e-mail: ...
5. Present Address: ...
...
Telephone Number (Res): ... Mobile: ...
6. Permanent Address: ...
...
Telephone Number (Res): ... Mobile: ...
7. Name of Guardian (other than parents): ...
Relation: ... Occupation: ...
Address:...
Telephone Number (Res): ... Mobile: ... e-mail: ...
8. Details of S.S.C Examination:
Name of previous school: ...
Medium of instruction of last school: ...
Education Board: ... Passing Year: ...
Examination Roll No: ... Registration No: ...
TICK (√) THE SUBJECT IN THE FIRST ROW AND THE LETTER GRADE IN THE NEXT ROW
Bengali English Maths Physics Chemistry Biology BGS Religion H.
Maths ICT Optional Sub ... GPA
Total Marks without optional
subject
9. Subject intended to study (For H.S.C) :
Compulsory: (1) Bengali (2) English (3) Information & Communication Technology
Elective: (4) Physics (5) Chemistry (6) ... (Higher Mathematics / Biology / Statistics)
Fourth Subject (Optional subject): (7) ... (Higher Mathematics / Biology / Statistics) Note:
Students will select one subject as Elective Subject and another as Optional Subject from Higher Mathematics, Biology and Statistics.
Male Female
Three Copies of Passport
size Colored Photographs
Some Important Data About The Candidate
10. Did your son/daughter suffer from any serious ailment? Mark in the appropriate box. Yes No 11. If yes, please state the nature of illness and duration of the ailment. (with dates)
...
...
...
12. Is your child suffering from any chronic disease which disturbs his / her academic pursuit? If yes, write its nature : ...
...
...
13. In case of emergency whom to inform (Other than the parents)
Name: ... Relation...
Phone: House... Mobile...Work Place...
Mailing Address: House No:... Road No:... Block:...
Post Code... District... e-mail: ...
I / We hereby declare that the information furnished in this application form is correct to the best of my / our knowledge. I / We also promise that the child will abide by all the rules and regulations / instructions of the institution. I / We also declare that, we shall accept the decision of the college authority regarding any issue related to academic or discipline of the student.
... ... ...
Signature of Father / Guardian Date: ...
Signature of Mother Date: ...
Signature of Student Date: ...
... ...
Signature of the President Admission Committee Date: ...
Signature of the Principal
Date: ...
