ADMISSION SESSION - 2019
Form No  :
Course  :
Student Name  :
Sex  : Male    Female
Father's Name  :
Mother's Name  :
* Date of birth  :

Paste recent
3.5 X 4.5 cm passport size colour photograph with date

Std.X School : 
Xth Board : 
CBSE ICSE JSEB BSEB OTHERS
Year : 
2021 2020 2019 2018 Year
Std.XII School : 
XIIth Board : 
CBSE ICSE JSEB BSEB OTHERS
Year : 
2021 2020 2019 2018 Year
Current Class : 
VIII Std IX Std X Std XI Std XII Std XII Passed
Medium : 
English Hindi
Prerna Classes Ex student : 
None Small Step Aspire Aspire One Swift Triumph Roll No :
Other Course RollNo :
%Marks Obtained In The Last Pre-Board/Board Examination(as applicable):
Maths Science (OR) Maths Physics Chemistry
Caste  :
General OBC SC ST
Student's Residence  :
Local Outstation
Batch Time  :
Evening Morning
Present Address  :
City/District  :
State  :
Pin Code :
Permanent Address  :
City/District  :
State  :
Pin Code :
Mother Tel No  :
Father Mobile No :
Guardian e-mail Address  :
Centre  :
DOA :
For DD / Cheque :
Number : DD / Cheque Date :
Bank : Branch :
Amount :
We have read and understood the terms and conditions for admission to Prerna Classes. We accept and agree to be bound by the same.
 
Create Date : Place :