HIMALAYAN WHITEHOUSE INTERNATIONAL S. SCHOOL

Baneshwor, Kathmandu
015199584/730 | mailreply@whitehouse.edu.np

APPLICATION FORM

FOR GRADE XI

Baneshwor, Kathmandu
Tel: 015199584/730
URL: -
E-mail: mailreply@whitehouse.edu.np

Fields with (*) are compulsory.

Grade Applied For *:

Science Management Law

Personal Information

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

Date of Birth*:

B.S.

A.D.

Gender*: Male Female Other

Age:

Nationality*:

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

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