Admission – medhaprakashmission.com

MEDHA PRAKASH MISSION (H.S)

Sahabazpur (Near Stand), Kaliachak, Malda, 732201

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Student Admission Form

Personal Information

Student Photo (Passport Size: 2x2 inches)* JPG or PNG, maximum 200KB, passport size (2x2 inches)

Student Signature (Max 200KB)* JPG or PNG, maximum 200KB

Admission Class*

Exam Center*

Student Name*

Date of Birth*

Gender*

Religion*

Nationality*

Caste*

Father's Details

Father Name*

Father's Qualification*

Father's Occupation*

Mother's Details

Mother Name*

Mother's Qualification*

Mother's Occupation*

Guardian's Details

Guardian Name*

Relation*

Guardian's Mobile*

Guardian's Occupation*

Guardian's Annual Income*

Residential Info

Present Address

State **

District **

Village / Town **

Post Office **

Police Station **

Pin (only Number) **

Permanent Address Same as Present Address

Permanent Address

State **

District **

Village / Town **

Post Office **

Police Station **

Pin (only Number) **

Previous School Details (Optional)

Previous School Name

Previous School Address

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