DYNAMIC SECONDARY SCHOOL

Phone

081541126

Email

dynamickohalpur@gmail.com

Location

Kohalpur- 11, Banke

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ACADIMIC PROGRAM

Higher Secondary Program

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INFORMATION OF STUDENT

Name of the student In English (In Block letters)

First Name

Middle

Last

विद्यार्थीको नाम (देवनागरीमा)

Date of Birth:

In B.S.

In A.D.

Gender:

Nationality:

Religion:

Contact No.:

ACADEMIC INFORMATIONS

Admission Permission for Grade:

To be admitted as: Day scholar Hostel student:

Previous school's name & address (for new only):

Reason for leaving school:
Academic result of previous grade:
Grade: GPA:

Awarded in any field of ECA:

Father’s Name:

Occupation: Qualification: Phone

Mother’s Name:

Occupation: Qualification: Phone

Permanent Address:

District	Municipality	Ward No	Tole

Temporary Address:

District	Municipality	Ward No	Tole

Local Guardian’s Name: Mobile No.:
Vehicle Station / Bus Stop:
Field of Interest:

Document Submitted: Mark Sheet Character Birth Certificate

English	Nepali	Math	Science	Grand Total	Percent	Result

Specific Physical, Mental, Habitual Weakness of the Student:

Commitment by the Student & Guardian:
I hereby agree to take any kind of action by the institution on the violation of rules and regulations of school and I shall have no objection whatever the consequence.

____________
Guardian

_________________
Student

____________
Principal

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