Chettipalayam , Puliyur C.F , Karur - 639114 .
Phone: +91 9786696574 / 6382222819
Email: info@chettinadvidyamandir.org
Website: https://www.chettinadvidyamandir.org/

Admission Form

Academic Details

Academic Year

Child's Details

Name of the child

Gender

Date of Birth

Age

Place of Birth

School Last attended

Reason for leaving

Board Last Studied

Class to which admission is sought

II Language

III Language

Nationality
Religion
Community
Caste
Mother Tongue
Language Spoken at home

Enquiry Source

Blood Group

"Does the child have any allergies or medical history that needs to be mentioned?"
Number of sibling
Admission no. of sibling(s) if any, studying here:

Note: Clicking the add button will display the sibling details.

Admission No Name Class Session Delete Student Id
No Records Found

Parent Details

Father

Mother

Father's Email

Mother's Email

Father's Mobile No

Mother's Mobile No

Local Mobile No

Family Structure

Address

Street

City

Country

State

District

Zip

Profession / Designation / Others

Father's Occupation

Mother's Occupation

Position Held

Position Held

Name of the Organization

Name of the Organization

Father Office Address

Mother Office Address

Annual Family Income

Student General Information

Aadhar number of child

EMIS Number

Passport number

Place of Issue

Validity

Whether certificates are attached

Identification mark

Identification mark2

Station

Birth Certificate

Community Certificate

Transfer Certificate

your image
Passport Size Photo
your image
Family photo

Do you require transport facility ?

If yes, point of boarding

Do you require hostel facility ?
your image
Student's Photo
your image
Local Guardian's Photo
your image
Visiting card size family photo
Boarding
Parent Guardian's Name
Guardian's Mobile No
Guardian's Address for Communication
Hometown
Distance of hometown from school(kms)

Personal Details

Allergy (If any)

Serious Ailment(if any)

Medication Details to be given(If any)

I assure you that my child will follow the rules and regulations as indicated by the authorities.

Details of Bank Account (Heading)

Name of the Bank

Branch

Account Number

Re-enter Account Number

IFSC/ RTGS/ NEFT Code

Account Holder’s Name (as in bank records)

I understand that fee once paid is neither adjustable nor refundable

Previous history of pupil

Name of the school

Recognised or Unrecognised

Standard From

Standard To

Year of admission

Year of withdrawal

How did you come to know about CVM and why would you prefer your child to study here?

Details about your sibling

Name

Class

School

Student should submit two choice of scheme of subjects clearly mentioning the course of study.

Schemes requested will be offered only if a viable number of students apply for it.

When making the selection, please keep in mind the course requirement for undergraduate study.

Kindly fill the preferences in the spaces provided below:

Details Regarding examination appeared

CBSE ICSE SSLC Others

Name of the Qualification Examination

Registration Number

Year and month of passing

Medium of Instruction

Does the child have any learning difficulty?

Yes No

If so, Kindly specify the level of difficulty(therapy / treatment)

I declare that i will not ask for a change in date of birth, Name the future.
I have read the brouchure and I undertake assure that will abide by them.
I understand that the fee once paid is neither adjustable nor refundable.
I certify that the particulars given above are correct and true.

DECLARATIONS

DECLARATIONS - 1

I agree to allow Chettinad Vidya Mandir to use my child's photograph, sample of his / her work which may include written work, audio and visual materials to use for educational training, commercial and / or promotional purposes relating to the school's activities, or those related activities of which it approves. I acknowledge that the school is not responsible for loss/damage to any personal property like gadgets, gold ornaments brought to school.


Please note that school fee is non-refundable. The term fee must be paid by the date set by the school. Nonpayment of term fee by the due date would result in late fee as per school management and the term fee policy

DECLARATIONS - 2

I/We declare that the information furnished by me/us is true to the best of my knowledge and belief. I promise that, if given admission, my child and myself will abide by the rules and regulations of Chettinad Vidya Mandir. I understand that if I am found to have falsified or inaccurately presented any information about admission, the admission is liable to stand cancelled.


I understand that the fee once paid is neither adjustable nor refundable.
Payment Type