SPRINGDALE ACADEMY

10th MILE,

KALIMPONG

DISTRICT DARJEELING

WEST BENGAL 734301

ADMISSION FORM

q BOARDER q DAY-SCHOLAR

(Please tick the correct box)

NAME OF THE STUDENT : ______________________________________________

SEX __________________   DATE OF BIRTH : (D/M/Y) ______________________

ADMISSION SOUGHT FOR CLASS : _______________________

NAME & ADDRESS  OF PREVIOUS SCHOOL :______________________________

________________________________________________________________________________________

CLASS IN WHICH THE STUDENT WAS STUDYING PREVIOUSLY :_______________

PREVIOUS SCHOOL BOARD :___________________________________________

                                   (Whether ICSE / CBSE / Madhyamik/ State Board/ Unaffiliated School)

FATHER'S NAME : Mr.__________________________________________________

ADDRESS :__________________________________________________________

               __________________________________________________________

OCCUPATION_____________________________________________________________________________________

MOTHER'S NAME : & ADDRESS _________________________________________

                    ______________________________________________________

CONTACT PHONE NUMBER/S ___________________________________________

EMAIL ADDRESS (IF ANY)_____________________________________________

SUPPORTING DOCUMENTS ATTACHED :___________________________________

_________________                                                                  ___________

(Student's signature) if possible                                                                            Parent/Guardian's signature

                                                     Date :____________________________