Elixir Academy

Chabahil, Kathmandu
01-5712105, 4114460 | info@elixir.edu.np

APPLICATION FORM

FOR GRADE XI

Chabahil, Kathmandu
Tel: 01-5712105, 4114460
URL: elixir.edu.np
E-mail: info@elixir.edu.np

Fields with (*) are compulsory.

Application No. : 5

Grade Applied For *:

XI-Management (Computer Science) XI-Management ( Hotel Management )

Personal Information

Name of Applicant (Full Name)*: REG. NO.:

Date of Birth*:

B.S.

A.D.

Gender*: Male Female Other

Age:

Nationality*:

Religion :

Caste :

Academic Information

PRE BOARD SEE CBSE ICSE IGCSE OTHERS NONE

Name of Previous School*:

Class Attended:

Year*:

GPA*:

S.N.	Subject	Marks	Action(s)
1.
2.
3.
4.
5.
6.
7.
8.
1.
CGPA *

Parent's Information

Father's Name *:

Email:

Occupation *:

Mobile No.*:

Name/Address of Office:

Telephone(Home):

Mother's Name*:

Email:

Occupation*:

Mobile No*:

Name/Address of Office:

Telephone(Home):

Local Guardian's Name *:

Address:

Relationship*:

Occupation:

Mobile No.*:

Telephone(Home):

CONTACT ADDRESS

PERMANENT ADDRESS

Province :

District :

Municipality :

CURRENT CONTACT ADDRESS

Same as Permanent Address

Province:

District :

Municipality :

Declaration

I wish my son/daughter or ward bought up and trained in accordance with the ideals and norms determined by the authorities of Elixir Academy. I understand and agree that s/he is liable to dismissal for inadequacy in his / her studies, for misconduct, non-payment of school fee when due, or any other reason which the school authorities deem make his/her continuance at the school undesirable.

Student Image :

Other Document *:

Date*

Parent's Signature

Principal Signature