Loyola Higher Secondary Regisration Form

Online Higher Secondary School Admission Form

Name (BLOCK LETTERS) as in Cl. X Admit Card

First Name

Middle Name

Last Name

Gender

Marital Status

Blood Group

Category

Date of Birth

Tribe

Religion

Please specify none-Catholic and others:

Personal identification mark

Permanent (Home)Address

District

State

Pincode

Present (Williamnagar)Address

District

State

Pincode

Email Id (student)

Mobile Number (student)

PEN (Permanent Education Number) :

Differently-abled(Yes/No)

Height (in cm)

Weight (in kg)

Contact Details

Father Name

Age

Education

Occupation(Specify)

Whether belongs to Urban / Rural

Father Contact Number

Mother Name

Age

Education

Occupation(Specify)

Whether belongs to Urban / Rural

Mother Contact Number

Local Guardian

Age

Education

Local Guardian Occupation(Specify)

Whether belongs to Urban / Rural

Local Guardian Number

Details of examination passed CL-X

Name of Board

School Name

Year of passing

Roll No.

Percentage(%)

Appeared as

Honors Subjects Offered (Indicate your choice of honors)

AADHAAR Number:

Subject Offered

Undertaking

I have read and understood the prospectus and promise to abide by the rules and regulations of the college in matters of study, attendance, discipline and conduct.