GOVERNMENT OF MANIPUR
DIRECTORATE OF EDUCATION (SCHOOLS)
APPLICATION FORM FOR ADMISSION TO CLASS XI OF 8 SELECTED GOVT. HR. SEC. SCHOOLS
Note: Please read the INSTRUCTIONS carefully before filling up the Application Form.
1. Name of the Candidate (as given in the Matric Certificate):
2. Mother's Name (as given in the Matric Certificate):
3. Father's Name (as given in the Matric Certificate):
4. Date of Birth:
D
D M M
Y
Y
Y
Y
5. Gender:
6. Category:
7. For OBC:
(Tick appropriate one)
(Tick appropriate one)
(Indicate Sub Caste)
Male
Female
Gen
SC
8. Contact Number :
ST
OBC
9. E-mail ID (Only in Capital Letters):
10. If differently abled not less than 40% as per the Person with Disabilities Act, 1995 (tick appropriate one):
Yes
No
If yes, tick
Low Vision/ Blind(VH)
Locomotor Disability/C.Palsy(OH)
Hearing Impaired(HI)
% of disability
11. Class X Board Result Details:(Enclose copies of relevant Documents: Refer Para 6 of Instruction)
Name of Board
Year of
Passing
School Last Attended
12. Stream of Course applied for (Tick appropriate one):
Arts
Science
Total Max. Total Marks/ % of marks
Grade Obtained
Marks
scored
Division/
Rank
Commerce
13. Subject combination (Code No.) applied for (may refer INSTRUCTIONS for filling up form):
14. School preference (as per category of school as in annexure A):
4th Preference
1st Preference
5th Preference
2nd Preference
rd
6th Preference
3 Preference
7th Preference
8th Preference
15. Joint declaration by the applicant and his/her Parents/ Guardian:
I declare that entries made by me in this Admission Form and the documents submitted by me are true in all respects and in case,
any information is found to be false, this shall entail automatic cancellation of my admission besides rendering me liable to such action
as the Department may deem fit.
I note that my admission to the school and my continuance on its rolls are subject to the provisions/ rules of the Department
issued from time to time. I shall abide by the rules of discipline and proper conduct.
Signature of the Parents/ Guardian
Signature of the Candidate
16. Address for Correspondence:
17. Photograph:
Name:
S/o or D/o:
Paste one recent passport
sized photograph of 3.5 x
4.5 cms duly attested by a
Gazetted Officer
Address:
District:
State:
PIN Code:
Code No.
(To be filled up by the school)
ACKNOWLEDGEMENT SLIP(To be issued to the applicant)
Code No.
(To be filled up by the school)
Received a duly filled in Admission form along with processing fee(Rs. 100) in respect of :
Mr./Ms.
of
Date of Receiving
* * * Submit this form only.
Signature of the receiving Official with Seal of the School.
INSTRUCTIONS
1. The Application form should be filled up in Capital Letters only.
2. Use blue or black ink ball point pen only.
3. Optional Subjects: The Code for each of the optional subject combinations should be
filled up at space provided at Sl. No. 13 (Ref. Annexure – D) of the Form.
4. School Preference: The code for schools opted/ preferred should be filled up at space
provided at Sl. No. 14 of the Form (Ref. Annexure – A). Example is given below.
1st Preference
2nd Preference
3rd Preference
TGHS
IGHS
ASHS
4th Preference
5th Preference
6th Preference
LHSS
5. The Department reserves the right to allot admission in any of the Schools if the
Candidate can’t be accommodated as per their preference.
6. Photostat copies of the following documents should be enclosed (Original documents
should be produced at the time of Admission):
i) Mark sheet of passing High School Leaving Certificate Examination or its
equivalent certificate.
ii) Provisional certificate of passing High School Leaving Certificate Examination or
its equivalent certificate (for ascertaining date of birth).
iii) Migration/ Transfer Certificate.
iv) Character certificate.
v) Income certificate of parents.
vi) Caste certificate, disability certificate, sports achievement certificate, etc. if any.
vii) Eligibility Certificate (in case of students passed out from Board other than
BOSEM.
7. A processing fee of Rs. 100/-(one hundred only) in cash is to be paid while
submitting the Form.
8. The cut-off mark shall be as follows:
a. Science – 50%
b. Arts – 40%
c. Commerce – 40%
9. The last date for submission of duly filled in application form shall be 6th June, 2014.
10. Incomplete forms/documents shall be liable to be rejected.
11. The application form may be submitted at any of the 8(eight) Schools included under
the Common Admission Scheme during Office Hours.
Annexure - A
LIST OF 8 SELECTED SCHOOLS SHOWING SCHOOL CODE
School
Sl.
Category
Code
Co-Education
ASHS
2 C.C. Hr. Sec. School
Boys
CCHS
3 Ibotonsana Girls Hr. Sec. School
4 Johnstone Hr. Sec. School
Girls
IGHS
Boys
JHSS
5 Lamlong Hr. Sec. School
Co-Education
LHSS
6 Model Hr. Sec. School
7 Ram Lal Paul Hr. Sec. School
Co-Education
MHSS
Boys
RPHS
Girls
TGHS
1 Ananda Singh Hr. Sec. Academy
8 T.G. Hr. Sec. School
LIST OF SCHOOLS WITH SUBJECT COMBINATION CODE AVAILABLE AT THE SCHOOL
Subject Combinations
Sl.
Name of School
Arts
Science
No.
1 Ananda Singh Hr. Sec. Academy A02, A03, A04, A05, A09, A11 S01, S04, S05, S06, S07
A06, A11, A18, A22, A28, A29,
2 C.C. Hr Sec School
S01, S05, S06
A30
A02, A03, A06, A13, A14, A19,
3 Ibotonsana Girls Hr. Sec. School
S01, S05, S06, S07, S08
A20, A23
S01, S02, S03, S04, S05,
4 Johnstone Hr. Sec. School
A02, A03, A19, A21, A24, A08
S06
Commerce
C02, C03, C06
C01, C03, C06
C01, C02, C03
C01, C02, C03
5 Lamlong Hr. Sec. School
A01, A02, A04, A06, A07, A27
6
A04, A11, A12, A13, A16, A25,
S01, S04, S05, S07, S08
A26
C01, C02, C06
7 Ram Lal Paul Hr. Sec. School
A06, A07, A10, A12, A15, A21
C01, C02, C06
8 T. G. Hr Sec School
A02, A03, A06, A11, A12, A14, S01, S02, S04, S05, S06,
A15, A16, A17
S07
Model Hr Sec School
S01, S04, S07
Annexure - B
S01, S04, S05, S06
LIST OF SCHOOLS SHOWING THE NAMES OF MIL SUBJECT AVAILABLE AT THE SCHOOL.
1 Ananda Singh Hr. Sec. Academy Manipuri, Hindi, Alternative English & Thadou Kuki
2 C.C. Hr. Sec. School
Manipuri, Hindi & Alternative English
3 Ibotonsana Girls Hr. Sec. School Manipuri, Hindi & Alternative English
4
5
6
7
8
Johnstone Hr. Sec. School
Lamlong Hr. Sec. School
Model Hr. Sec. School
Ram Lal Paul Hr. Sec. School
T.G. Hr. Sec. School
Manipuri, Hindi & Alternative English
Manipuri & Alternative English
Manipuri, Hindi & Alternative English
Manipuri & Alternative English
Manipuri, Hindi & Alternative English
Page 1 of 1
C01, C05, C06
C01, C02, C03, C04, C06
Annexure - C
LIST OF SUBJECT COMBINATION INDICATING COMBINATION CODE
Sl.
Optional Subject Combination
Annexure - D
Code
1. Arts Stream:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Sl.
1
2
3
4
5
6
7
8
Sl.
1
2
3
4
5
6
Economics, Geography, Mathematics & Statistics
History, Political Science, Education & Economics
History, Political Science, Education & Philosophy
Economics, Geography, Political Science & Elective Manipuri
Economics, Geography, Political Science & Elective Hindi
Political Science, History, Education & Geography
Political Science, History, Education & Elective Manipuri
Political Science, History, Education & Elective Hindi
Political Science, History, Education & Home Science
Political Science, History, Economics & Geography
Political Science, History, Economics & Mathematics
Political Science, History, Economics & Statistics
Political Science, History, Economics & Home Science
Political Science, Economics, Education & Home Science
Political Science, Economics, Education & Elective Manipuri
Political Science, Economics, Education & Elective Hindi
Political Science, Economics, Education & Music
Economics, Geography, Mathematics & Philosophy
Economics, Geography, History & Philosophy
Economics, Physical Health Education, History & Philosophy
Political Science, Mathematics, Education & Geography
Political Science, History, Elective Manipuri and Physical Health Education & Sports
Economics, Political Science, Education & Geography
Political Science, History, Education & Elective Manipuri
Political Science, Education, Economics & Philosophy
Economics, Computer Science, Mathematics & Geography
Political Science, Home Science, Education & Geography
Philosophy, Geography, Political Science & Education
Political Science, Mathematics, Economics & Physical Health Education
Political Science, History, Statistics & Education
Optional Subject Combination
2. Science Stream:
Physics,
Physics,
Physics,
Physics,
Physics,
Physics,
Physics,
Physics,
Chemistry,
Chemistry,
Chemistry,
Chemistry,
Chemistry,
Chemistry,
Chemistry,
Chemistry,
Biology & Mathematics
Biology & Anthropology
Biology & Geology
Mathematics & Statistics
Mathematics & Computer Science
Mathematics & Engineering Drawing
Biology & Home Science
Biology & Computer Science
Optional Subject Combination
3. Commerce Stream:
Accountancy,
Accountancy,
Accountancy,
Accountancy,
Accountancy,
Accountancy,
Business
Business
Business
Business
Business
Business
Studies,
Studies,
Studies,
Studies,
Studies,
Studies,
Economics & Mathematics
Economics & Computer Science
Mathematics & Computer Science
Economics & Education
Economics & Home Science
Mathematics & Statistics
A01
A02
A03
A04
A05
A06
A07
A08
A09
A10
A11
A12
A13
A14
A15
A16
A17
A18
A19
A20
A21
A22
A23
A24
A25
A26
A27
A28
A29
A30
Code
S01
S02
S03
S04
S05
S06
S07
S08
Code
C01
C02
C03
C04
C05
C06