NATIONAL INSTITUTE OF SCIENCE

Balkumari Gwarko,Lalitpur
015186497 | info@patannist.edu.np

APPLICATION FORM

FOR GRADE XI

Balkumari Gwarko,Lalitpur
Tel: 015186497
URL: www.patannist.edu.np
E-mail: info@patannist.edu.np

Fields with (*) are compulsory.

Grade Applied For *:

Management Science Law

Personal Information

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

Gender*: Male Female Other

Nationality*:

Email*

Phone (Res.):

Mobile No.*:

Religion :

Caste / Ethnicity :

Blood Group:

Province:

Municipality:

Street:

Academic Information

PRE BOARD SEE CBSE ICSE IGCSE OTHERS NONE

Name of SEE Appeared School, Address*:

SEE Appeared Year*:

GPA*:

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

Parent's Information

FATHER'S INFORMATION

Father's Name *:

Email:

Occupation *:

Mobile No.*:

Post:

Office:

Telephone(Office):

MOTHER'S INFORMATION

Mother's Name*:

Email:

Occupation*:

Mobile No*:

Post:

Office:

Telephone(Office):

GUARDIAN'S INFORMATION

Local Guardian's Name *:

Address:

Relationship*:

Occupation:

Mobile No.*:

Telephone(Home):

CONTACT ADDRESS

PERMANENT ADDRESS

Country :

Province :

District :

Municipality :

Ward No :

Street :

House No:

CURRENT CONTACT ADDRESS

Same as Permanent Address

Country :

Province:

District :

Municipality :

Ward No :

Street :

House No:

Other Information

How do you know about NIOS ? *

Social Media

Relatives

Teachers

NIOS Alumni

Self Visit

Other

Do you require transportation?*

Yes No

If Yes, please mention the nearest BUS STOP and landmark:

If ‘No’, Please mention how you will come to school:

Details of referees you would like us to contact, if required:

1 . Name:

Relation:

Phone No:

Email:

2 . Name:

Relation:

Phone No:

Email:

Declaration

All the information provided in this application form is correct, complete and true to the best of my knowledge and belief.
I understand that the school reserves the right to cancel the application and subsequent admission on the basis of incorrect or incomplete information I may have furnished.
I shall abide by the rules and regulations of the school.

Student Image :

Student Signature