ADMISSION FORM

Registration for the session

Paste your
Class to which admission is photo here
sought (Passport size)

Subject Preference 1
Please specify, if applying for Class XI)

Form No. : __ __ __ __
Reg. No. : __ __ __ __ __
Subject Preference 2
Please specify, if applying for Class XI)

Child Details (Mention the details in CAPITAL LETTERS)

First Name Last Name

Age as on 1-Apr-20 __ __
Date of Birth __ __ / __ __ / __ __ __ __
(As in Certificate issued by Municipal Corporation)
Birth Certificate No.

Place of Birth State of Birth

Caste
Category (General/ST/SC/OBC/Other)
Attach certificate
Religion

Nationality Mother Tongue

Gender Blood Group

Child with special needs YES NO

If YES, please specify and attach the medical certificate

Parents Details (Mention the details in CAPITAL LETTERS)

Father’s Name

Education

Profession/Occupation

Name of the Organization

Designation Mobile No.

Aadhar No. of Father Annual Income of Father

Office Address

Area (Apartment/Plot/Sector/Locality) ___________________________________________________

City _____________________________________ Pin Code ________________________________

Mother’s Name

Education

Profession/Occupation

Name of the Organization

Designation Mobile No.

Aadhar No. of Mother Annual Income of Mother

Office Address

Area (Apartment/Plot/Sector/Locality) ___________________________________________________

City _____________________________________ Pin Code ________________________________

Guardian Details (Mention the details in CAPITAL LETTERS, if applicable)

Guardian’s Name

Relationship with the child Education

Profession/Occupation

Name of the Organization

Designation Mobile No.

Aadhar No. of Guardian Annual Income of Guardian

Office Address

Area (Apartment/Plot/Sector/Locality) ___________________________________________________

City _____________________________________ Pin Code ________________________________

Contact Details of Parents (Mention the details in CAPITAL LETTERS)

Present Residential Address

House/Door/Flat No. Street/Locality

District City

State Pin Code

Mobile Number Residence Telephone No.

Email ID
 Permanent Residential Address

House/Door/Flat No. Street/Locality

District City

State Pin Code

Mobile Number Residence Telephone No.

Email ID

Emergency Contact Details

Name of the Person Relationship with the student

House/Door/Flat No. Street/Locality

District City

State Pin Code

Mobile Number Residence Telephone No.

Email ID

Sibling Details (Mention the details in CAPITAL LETTERS)

Sl. Gender Studying/Studied in the Registration Year of

Child’s Name school (Yes/No)
No. (Male/Female) If No, mention details of the school
No. Admission
Previous School Details, if applicable (Mention the details in CAPITAL LETTERS)

Name of the Medium of Reasons for

Name of the School Address of the School
Board Instruction Leaving the School

Last Class Attended CGPA/Percentage

Month/Year __ __/__ __ __ __

Result Passed Detained Awaited

Proficiency in Language/Language that the child can speak/understand (Tick as appropriate)

Language Speak Read Write

English
Hindi
Sanskrit
Other Language(s) known,
please specify

Transport Details (Mention the details in CAPITAL LETTERS)

Transport required YES NO

If YES, mention the details below

Approx. Distance in km from the school

Stop Name/Landmark
0 - 5 5 - 10 10 - 15 Above 15
 Do you know anyone at Acharyakulam or Patanjali Yogpeeth Trust? YES NO
If YES, Please mention in detail.

Name Designation Department Relationship

Why do you want your child to study at Acharyakulam, Ranchi

Documents Required at the time of Registration

(Photocopy of the documents to be submitted along with the admission form)

1. Document no 1: Birth Certificate from Municipal Corporation bearing the logo of the State Government
and Birth Certificate number.
2. Document no 2: Only following Proof of Residence (in the name of the child’s Father or Mother) accepted as
Address proof of the Child (No other address proof will be accepted) - Unique Identification Card (Aadhar
Card) / Voter ID Card / Post-paid Mobile Bill / Electricity Bill /Passport / Gas connection / Ration Card
(having mother and father name along with name of child).
3. Document no 3: If the sibling(s) studying in the same school, photocopy of the ID Card issued by the
school office for the Academic Session 20__ __/__ __. Only real brother/ sister studying in the school will be
considered as sibling.
4. Document no 4: In case of applicants with Special Needs, a copy of certificate of Disability from a Medical
Officer of Govt. Hospital should be submitted along with the registration form.
5. Document no 5: Proof of your relevant category (ST/SC/OBC/Other).
6. Document no 6: Appropriate documentation in case of Single Parent (presently running divorce case in
the court will not be considered, either widow/widower or divorced would be considered). Appropriate
documentation in case of change in the name of mother/ father after marriage, divorce, adoption etc.
 7. Document no 7: ID proof of both Father and Mother or Guardian, as applicable.
8. Document no 8: Transfer Certificate for admission in class I and above.
9. Document no 9: Report Card of the previous school and class for admission in class I and above.
10. Two passport size photograph of the child and one photograph each of parents (father and mother or guardian).

Instructions

1. Duly attested photocopies of all the documents must be attached with the admission form, however original
documents will be required for verification at the time of admission.

2. Transfer certificate in original will be required at the time of admission along with one copy of recent stamp
sized photograph of the child.

3. Once admission is approved, the student will not be allowed to withdraw from the school during the academic
session without prior permission of the principal.

4. The school provides transport facilities but it is not bound to offer a seat in the bus which is completely based
on availability of seats and plying of the bus in the particular route. It will be the responsibility of the parents/
guardians to drop/pickup the child from the specified bus stop. Students will not be allowed to discontinue
transport facility during the academic session.

5. The Admission Form submitted at the school reception or to the Admission Officer does not entitle the
child for admission in school unless the child’s name is present in the Selected List post the completion of
registration and evaluation formalities.

6. Incomplete forms are liable to be rejected. Kindly avoid any kind of cutting, fluid markings and over-writing
in the form.

Declaration/Undertaking

1. I/We fully understand, that the school, on accepting the registration of my/our child is not in any way bound
to grant admission which is purely based on the availability of seats. I/We also understand that the decision
of the principal regarding admission will be final and binding.

2. In the event my/our child gets selected for admission, I/We shall have no objection to the school Medical
officer giving inoculation against Typhoid A,B and Cholera to my/our child.

3. In case of withdrawal of my/our child, I/We agree that admission fee and other fees will not be refunded.

4. I/We also take the responsibility that my/our child will attend school regularly and maintain 75% attendance
as per the school rules.

5. I/We agree to abide by the rules and regulations of the school. If any information or declaration furnished by
me/us proves to be false, my/our child’s candidature may be cancelled at any stage.
 Father’s Passport Size Mother’s Passport Size Guardian’s Passport Size
Photograph Photograph Photograph

Father’s Signature Mother’s Signature Guardian’s Signature

(if applicable)

Father’s Name Mother’s Name Guardian’s Name

(if applicable)

For Office Use Only

Admission granted YES NO

Date of approval ________________

Class __________ Section __________ Roll No. __________ Date of Admission __________

Remarks

Signature of the Admission Officer Signature of the Principal Signature of the Chief Administrator

Name of the Admission Officer Name of the Principal Name of the Chief Administrator