This form consists of two pages GOVERNMENT OF KERALA DEPARTMENT OF VOCATIONAL HIGHER SECONDARY EDUCATION APPLICATION FOR ADMISSION TO VOCATIONAL HIGHER SECONDARY COURSE FOR 200...-200... Conducted in the .......................................................................... (Name of School) Vocational Subjects Chosen 1st Choice ........................................................ 2nd Choice ................................................... 3rd Choice ........................................................ 4th Choice ........................................................ 5th Choice ........................................................ (See prospectus for details of Vocational Subjects offered in the Institution) Whether opted part III : Yes/No Office Seal 1. Name (in block letters) 2. Address for Communication 3. Age & Date of Birth (Age as on 1st June of the year of admission. Attested copy of the certificate to prove age to the attached) 4. Whether a native of Kerala Yes / No 5. Name, occupation and annual income of the Parent /Guardian with address 6. Caste, Community and Religion (State whether Scheduled Caste/Scheduled Tribe/ Other Eligible Community/Other Backward Classes) 7. (a) Name of School in which the applicant studied for the S.S.L.C/T.H.S.L.C Examination (b) Number of chances taken for passing the S.S.L.C/T.H.S.L.C Examination (c) Register number, month and year of each appearance 1. 2. 3. 8. Number & date of T.C issued from the institution last studied 9. Have you been in receipt of fee concession for any post -matric course earlier. If yes, state the details of concession enjoyed (Applicable for SC/ST and O.E.C candidates only) Yes / No / NA 10. Have you completed Pre-Degree or a qualification equivalent thereto ? Yes / No 1 :2: 11. Do you claim educational concessions from Government ? Yes/No If yes, state grounds 12. Are you a, (a) NCC Certificate holder (b) NSS Certificate holder (c) Child of Jawan / Ex-Serviceman (d) President's Badge in Scout/Guide holder (If yes, attested copy of the Certificate to be attached) Yes/No Yes/No Yes/No Yes/No Marks for the S.S.L.C/T.H.S.L.C Examination Subject Marks awarded Maximum marks English Social Science (C) Biology (D) Mathematics (B) Total marks secured in S.S.L.C/T.H.S.L.C. (A) (Attested copy of marks to be attached) The entries made above are correct as per the S.S.L.C/T.H.S.L issued to me. Place : .............................................. Date : ............................................... Signature of applicant DECLARATION BY PARENT / GUARDIAN I solemnly affirm that all the particulars in the application for admission submitted by my ward Shri/Smt/ Kum .......................................................................................... are true to the best of my knowledge and belief. I hereby undertake that my ward will abide by the rules and regulations framed by the authorities for the conduct of the V.H.S Courses from time to time. Place : .............................................. Date : ............................................... Signature of parent/guardian Name : Address : FOR OFFICE USE ONLY Bonus marks eligible = ...................... Index marks for Group I Courses (A+B) + Bonus if any = ...................... Index marks for Group II Courses (D) + Bonus if any = ...................... Index marks for Group III & IV Courses (A+C) + Bonus if any = ...................... Shri/Smt/Kum. ........................................................... Admitted to V.H.S. Course in ........................................................... Date of Admission ........................................................... Admission Number ........................................................... Signature of the Head of Institution 2
