Cost: Rs. 25/- ATOMIC ENERGY CENTRAL SCHOOLS Application Form for Admission to class I only

For the Academic Year 2015-16

For admissions in Class I under the SEEP (TNP) (This form can be viewed (read-only) at: www.aees.gov.in)

Sr. No. Admission No. ________________ (For Office Use) To The Principal ATOMIC ENERGY CENTRAL SCHOOL - _____________ (Tick () in appropriate box) ___________________________________________ Sir/Madam, I request you to admit my son/daughter/ward to class __________ of your school. The required particulars are given below:

1 Name of the pupil in full (in block letters and as stated in the Birth Certificate)

Surname First Name Middle Name

2 Date of birth In figures In words

D M Y

3 Place of birth Village: Taluka: Dist.: State:

4 Age as on 31st March of the year of admission Gender Male / Female

5 a) Name of the father in full (in block letters) a)

b) Name of the mother in full (in block letters) b)

6 Official address with designation of the parent( father and/or mother)

7 Complete Residential address with address proof

8 Aadhaar Card/Ration Card no. of the child & Blood Group

9 Monthly income of the parents

10 Telephone No. (if any) Office: ________________ Residence: ___________________ Mobile: ________________ E-mail: ______________________ Creche: _______________ Emergency contact no. __________

11 Name of the home town of the child Village: ________________ Taluka: ____________________ Dist. __________________ Nearest Rly. Stn. __________________

12 Is any other child of your family studying in AECS under SEEP/TNP? If yes, Furnish the following particulars

1. Name of the school: 2. Year of admission: 3. Name of the child: 4. Class/Sec:

13 If the child is not staying with the parents a. Name and Address of the guardian b. Occupation of the guardian c. Reason for staying with the guardian

SC ST OBC BPL

2015/

Affix latest

photograph

14 Mother tongue of the child

15 Identification Marks (any two) 1. 2.

16 Brief note about the parent himself and his work. Why does he want to admit his ward to AECS

17 Any other information which the parent/guardian wishes to furnish

DECLARATION BY PARENT/GUARDIAN

a) I hereby declare that the information given about my son/daughter/ward (name of the child) ________________________________ furnished by me is true and correct and that I will not demand any change in the date of birth mentioned at serial 2 at a future date.

b) I am also aware that if the information furnished above is found to be false or incorrect, the admission will be cancelled and the child withdrawn from the school.

c) I shall abide by the rules of the AEC schools (AEES). d) My child is not suffering from any congenital /chronic disease to my knowledge.

Date: ______________ Signature of the Parent/Guardian

Name: ____________________________________________________________________________________________________________

OFFICE USE Admit _____________________________________ to Class _______. Admitted to the Class _______ Admission no. ________ Folio no. ________ Receipt No. ____________. The name has been entered in the class register. Date: Class Teacher Principal

... ENCLOSURES RECEIVED

1. Original Birth Certificate is to be submitted at the time of admission in class I. The original certificate for proof of age in the form of a birth certificate issued by the competent authority may be enclosed in original. This will include certificates from Notified Area Council/ Municipality/ Municipality Corporation/ extract about the date of birth from records of Village Panchayat.

2. A certificate that the child belongs to the Scheduled Caste/ Scheduled Tribe/ EWS/OBC (Non-Creamy Layer)/ BPL, wherever applicable, issued by the competent authority in concerned State Government/ Union Government. If the same is not available for the child, the certificate in respect of either of the parents may be accepted initially for the purpose of admission. However, the certificate in respect of the child has to be submitted within a period of 03 Months from the date of admission.

3. Attested copies of Aadhaar card/Ration Card of parents alongwith the child. 4. Income Certificate in respect of parents issued by the employer concerned/ Revenue authorities 5. Proof of residence(essential) : A self-declaration in writing from the parent about distance may also be accepted to this effect 6. Any other document(s) as advised/required by the concerned Head of AEC School for the grant of admission.

Sr. No. RECEIPT

AECS- _____________ received an admission form from Master/Miss ______________________________ son/daughter of _____________________________________ for admission to Class ___________. I have personally verified copies of the required documents/enclosures which are attached herewith. Date: (Dealing Assistant)

2015 /