FORM NO:

ST. JOSEPH’S GIRLS’ NURSERY/PRE-NURSERY SCHOOL

CANTONMENT ROAD, CUTTACK, ODISHA
(Under the Management of St. Joseph of Annecy (India) Educational Society, Bhubaneswar)
APPLICATION FORM
(Academic Session 2022-2023)

Affix Affix Affix

Recent Passport size Recent Passport size Recent Passport size
Colour photograph of Colour photograph of Colour photograph of
Father Mother Child

Class for which admission is sought_______________________________________________

1.Name of the Student In block letters ______________________________________________________

2.Date of Birth

(In words) __________________________________________________________________________________________

3.Age as on 31-03-2022 :_________years __________months 4. Nationality:________________________

5. Mother Tongue: __________________6. Religion: _____________________7. Blood Group: _____________________

8.Category: SC ST OBC GENERAL

9. Family Particulars:

Father Mother
Name: Mr_____________________________________ __________ Mrs_______________________________________________
Qualification: __________________________________________ ___________________________________________________
Mobile No: __________________________________________ ________ ____________________________________________
Email-Id: __________________________________________ ________ ____________________________________________
Aadhaar No __________________________________________ ____________________________________________________
Occupation __________________________________________ ____________________________________________________
Name of the Organization:
______________________________________________ ___________________________________________________
Designation: _____________________________________________ ____________________________________________________
Office Address:____________________________________________ ___________________________________________________
_____________________________________________ ___________________________________________________
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10.Preferred Mobile Number for School SMS (Only One): ___________________________________________________

11.WhatsApp No for sending Official communication from school:_________________________________________

12.Email Id for sending Official communication from school:_______________________________________________

13.Residence Address: __________________________________________________________________________________________

__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________

14. Distance of Residence from the School: __________________________________________________________

15. Reason for seeking Admission to this School: ____________________________________________________________
_____________________________________________________________________________________________________________________

CERTIFICATE FROM THE PARENT

I / We here by certify that the above information provided by me / us is correct and I / We understand
that if any of the information is found to be incorrect or false, the ward shall be automatically debarred
from selection/admission process without any correspondence in this regard. I / We also understand
that the application / registration / short listing does not guarantee admission to my ward. I / We
accept the process of admission undertaken by the school and I / We will abide by the decision taken
by the school authorities

Signature of the Mother Signature of the Father

Name _________________________________________ Name ____________________________________________________
Date:- __________________
SCHOOL SPECIFIC PARAMETERS: Points Marking Column
(to be filled by office)

A) Christian Minority(Resident of Odisha) 50

YES NO

B) Siblings(own sister )
Name:___________________________________________ 10

Class________________________ Section:___________
C) Children of Alumna: YES NO
10
Name:________________________________________________
Year of Passing _____________________
D) Transferable job :(put √ mark) 10
(Central/ State Government/Bank & PSU
Employee only) 10
YES NO
E) Resident of Cuttack:

F) Professional/ Entrepreneur: (put √ mark) 10

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 RULES & REGULATION
1. Marking column is to be filled up by the School only.
2. Incomplete form will not be accepted.
3. The school reserves the right to reject any form which has incomplete or false information and
documents.
4. For Pre-Nursery class the age of the child as on 31-03-2022 must be between 3-4years and for
Nursery 4-5 years.

LIST OF DOCUMENTS TO BE SUBMITTED ALONG WITH THE APPLICATION FORM

AS APPLICABLE

1. Photocopy of Birth Certificate of the ward from the Municipal Corporation. (Self attested
by the parents.
2. Proof of Residence: Elector’s ID Card/Passport/Telephone Bill/Electricity bill/
Residential Certificate from Tahasildar. (self attested photocopy)
3. An attested photocopy of child’s Baptism Certificate and parents Baptism Certificate, (in
case of Christian Candidates only)
4. For alumna category (Ex-Students of St. Joseph Girls’ High School )- Certificate of Class X
(ICSE) of mother (self attested photocopy)
5. For sibling category- Last Report Card of sibling ( Self attested photocopy)
6. Certificate of parents in support of their proof as professional.
7. A Notarized declaration in Rs.10/- Non Judicial Stamp paper that they are practicing as
professional.
8. Medical Fitness Certificate of the Child from a Registered Doctor.
Note:
Issue of Application Form does not ensure Admission
Admission Fee paid will be Non Refundable.

Date for submission of the filled up form in the School Office-

22nd , 23rd & 24th November 2021.
Time – 9a.m -11a.m
Last date for submission of Application form 24th November 2021.

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