Form No………………………. Admission No………………………….

Date of Admission ………………

CENTRAL ACADEMY, RANCHI

Senior Secondary Co-educational School
[Affiliated to Central Board of Secondary Education, New Delhi]
Affiliation No. : 3430036 Affix a Passport
Bariatu Road, Ranchi - 834009 (Jharkhand) Size Photograph
Established Run and Managed by World Buddha Foundation
[As Buddhist Religious Minority School]
[Approved and recognized by National Commission of Minority Educational institution,
Govt. of India, New Delhi]
Phone No. : 0651-2541110, 9234300585
Website: www.centralacademyranchi.in Email ID : centralacademybr@yahoo.com

ADMISSION FORM

1 Name of the Candiadte (in Block letters) ……………………………………………………………………………………….

2 Sex : Male/Female …………………………………………………………………………………………………………………………..

3 Date of Birth: in figure …………….………………………… In words …………………………………………………………..

4 Mother's Name ………………………………………………………….. Occupation ………………………………………………

5 Father's Name …………………………………………………………………... Occupation ……………………………………….

6 E-mail ID : Mother …………………………………………………………….. Father …………………………………………………

Phone No. : Mother ………………………………………………………... Father …………………………………………………..

7 Permanent Address …………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………………………………………

8 Name & Address of Local Guardian …………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………..

Email Id: ………………………………………………………………. Phone No…………………………………………………………..

9 Nationality …………………………………………………………………………………………………………………………………………

10 Religion ………………………………………………………………………………………………………………………………………………

11 Caste …………………………………………………………………………………………………………………………………………………..

12 Aadhar No…………………………………………………………………………………………………………………………………………..
 13 Name of previous School …………………………………………………………………………………………………………………..

14 Previous class …………………………………………………………………………………………………………………………………….

15 TC No. & the date on which TC issued ..…………………………………………………………………………………………….

16 Name of the Board ..………………………………………………………………………………………………………………………….

17 For XI, Group Opted

Group I (1) English (2) Maths (3) Physics (4) Chemistry (5) Physical Education

Group II (1) English (2) Biology (3) Physics (4) Chemistry (5) Physical Education

18 (a) For Science Stram

Marks/GP obtained: English Maths Science Aggregate of Percentage Grand Total

Three Subjects in percentage/
CGPA
……….. ……….. ……….. ……….. ……….. ………..

(b) For Commerce Stram

Marks/GP obtained: English Maths Social Study Aggregate of Percentage Grand Total
Three Subjects in percentage/
CGPA
……….. ……….. ……….. ……….. ……….. ………..

DECLARATION
I hereby declare that the enrtries made by me in the application form are complete and true to the best of my
knowledge and based on records. I hereby promise you that my ward will abide by the rules and regulations concerning
discipline, punctuality attendance etc.

……………………………………….
Full Signature of Parents/Guardian

Date:……………………. Relation with Pupil …………………………….

………………………………………………………………………………………………………………
FOR OFFICE USE
……………………
Admission No………………….. Date of Admission ………………………………….

Admitted to Std…………………………….. Section …………………………………………….

Remarks …………………………………………………………………………………………………….
………... …………………………………………………………………………………………………….
………... …………………………………………………………………………………………………….

…………………… ………………………. ……………………………….

Date Signature of Clerk Signature of Principal