Mother's Public School, Khandagiri

Date: 06-03-2026

Mother's Public School, Khandagiri^™

Tapoban High School Road, Khandagiri, Bhubaneswar, Odisha-751030

Contact : 8112111112 / 7437900900

PLEASE USE CAPITAL LETTERS TO FILL IN THE FORM

APPLICATION FORM FOR ADMISSION
	Admission to Class Academic Year
NAME
DATE OF BIRTH	Child's Birth Certificate
NATIONALITY
GENDER	MALE FEMALE
CATEGORY
HANDICAP
STUDENT AADHAR CARD NUMBER
DETAILS OF SIBLINGS STUDYING IN THIS SCHOOL	NAME : CLASS : SECTION :
CURRENT ADDRESS
PERMANENT ADDRESS SAME AS CURRENT ADDRESS
MOTHER TONGUE
BLOOD GROUP
EDUCATION DETAILS	Name & Address of the School Attended with Phone No.	Year of Passing

DETAILS OF PARENTS

Details of Father		Details of Mother
NAME		NAME
EDUCATIONAL QUALIFICATION		EDUCATIONAL QUALIFICATION
OCCUPATION		OCCUPATION
MOBILE		MOBILE
E-MAIL		E-MAIL

DETAILS OF GUARDIAN
NAME
EDUCATIONAL QUALIFICATION
OCCUPATION
ADDRESS
E-MAIL
MOBILE

DOCUMENTS REQUIRED DURING ADMISSION

1. Photocopy of Birth Certificate	6. Photocopy of ration card (BPL Card/ APL Card)
2. Photocopy of Report Card	7. Original copy of Transfer Certificate
3. Present Postal Address Proof (Electricity bill/Telephone bill/Gas Connection Card etc.)	8. One Passport Size Colour Photograph
4. Photocopy of Aadhar Card of Ward & Parents	9. Blood Group Certificate from Red Cross or Similar Organization/Agency
5. Photocopy of Caste Certificate (SC/ST/SEBC/Other disadvantaged group)	10. Permanent Education Number (PEN)

DECLARATION BY THE PARENT / GUARDIAN

I do hereby declare that the date of birth of my son / daughter / ward, furnished by me is according to the birth certificate.