FORM FOR ADMISSION INTO GOVERNMENT S.T.ASHRAM SCHOOLS 1 Name of the Applicant : 2 Caste / Tribe Type : 3 Native Village / Mandal : 4 Distance to Hostel from Native Place : 5 Date of Birth as per school records : 6 Father's Name, Address, Occupa tion : 7 Annual Income details of Father (a) In case of Guardian, Guardian's Address : (b) Guardian's Name & Annual Income : 8 Name of the School in which he is studying : 9 Class in which student is studying at present : 10 Whether the applicant has resided in hostel before? If yes please give details of hostel & year : Signature of the Applicant Signature of the Head Master of the School with Seal COMMUNITY CERTIFICATE ( To be signed by any Gazetted Officer ) Sri / Smt. __ _____________________________ Son / Daughter of __________________________________ Resident of ________________________is an Indian National and belongs to Scheduled Tribe __________________ to the best of my knowledge and certify. He / She belongs to ________________ religion. Official Seal of the Office Signature Name in Capital letters Designation Full Address INCOME CERTIFICATE ( To be signed by Mandal Revenue Officer ) Sri / Smt. _______________________________ Son / Daughter of __________________________________ Resident of ________________________is an Indian National joint family, the annual income of the father/guardian's is Rs. _______________ (in words) ________________________________________________ to the best of my knowledge and certify. Official Seal of the Office Signature Name in Capital letters Designation Full Address DECLARATION OF STUDENT AND FATHER / GUARDIAN We, myself and my son / daughter abide by the rules and regulations as prescribed by the Government. We declare, if the details furnished above are false, we agree for any punishment imposed by the Government. SIGNATURE OF THE STUDENT SIGNATURE OF FATHER / GUARDIAN PROCEDURE: The applicant fill up the form and submit to the concerned Head Master.
