Jamia Tahzibul Islam

Mohalla Takiya Ahrora, Distt. Mirzapur (UP)

Admission Form

S.No. ………….                                                                     Scholar Register No. ……………...

1. Date of Application

2. Subject in which admissions is to be sought                    

3. Scholar’s name in full

4. Name and Address (home) of scholar’s father and his occupation

5. Name and Address (local) of Guardian applying

6. Relationship of the guardian to scholar

7. Coming from Urban or Rural area

8. Religion                    Cast

9. Date of Birth of scholar

10. Scholar’s age in years and months on 1^st of May at the time of Admission

11. School attended

12. Period of residence in U.P.

13. List of copies of Scholar’s Register filled (if any)

14. If entry 10 is blank the following certificate must be signed

…………………………………

                                                Father’s/Guardians Signature

I hereby certify that ………………………………… has not previously attend any recognized English or Vernacular Institution. I also certify that the date of birth of the scholar as here in stated in correct. 

…………………………………

                                                                        Father’s/Guardians Signature

N.B. –Issue of form does not guarantee Admission.