St. John Higher Secondary Residential School
Diphu Road, Indisen Village
Dimapur Nagaland, 797112
st.johndimapur.in
(+91)
Admission Form
Enter your admission information below
Name
*
First Name
Last Name
Gender
*
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Of which country are you a citizen?
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Caste
*
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ST
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GEN
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E-mail Address of Student
*
example@example.com
Mobile number of Student
*
Aadhaar number of Student
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Birth Date
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Year
Name & Address of Previous School
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year of passing H.S.L.C Exam
*
Class/Stream in which admission desired
*
Father Name
*
First Name
Last Name
Mother Name
*
First Name
Last Name
Permanent Address of Parents
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile number of Parent
*
WhatsApp number of Parent
*
E-mail Address of Father
example@example.com
E-mail Address of Mother
example@example.com
Occupation of Father
*
Occupation of Mother
*
Compulsory Local Guardian Contact for Emergency
***(Fill only if parents are not residing in Dimapur)
Name of Guardian
First Name
Last Name
Address of Guardian
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile number of Guardian
***Note: Student will be delivered to Guardian in case of emergency
Choose Subject combination according to Arts or Science Student
***Note: (Arts Compulsory Subject : English) (Science Compulsory Subject: English, Physics, Chemistry)
Subject combination of Arts Stream
Alternative English, History, Pol. Science, Education, Sociology
Alternative English, History, Pol. Science, Education, Informatics Practices
Alternative English, History, Pol. Science, Economics, Informatics Practices
Alternative English, History, Pol. Science, Economics, Sociology
Subject combination of Science Stream
Biology, Mathematics, Alt. English
Biology, Computer Science, Alt. English
Biology, Mathematics, Computer Science
Mathematics, Computer Science, Alt. English
Notes: -
Once admitted into the hostel one cannot become a dayscholar under any circumstances, even on medical ground.
All the students must attend classes of the optional subject (6th subject).
Only eligible students passing in the current academic year (i.e. 2023) will be admitted.
PRIVATE STUDENTS are not eligible for admission in class –11 Science.
If your son/ daughter suffering from any ailment? Please mention it in the medical report.
Students with
TATTOO MARKS ARE NOT ELIGIBLE FOR ADMISSION.
IMPORTANT: ALL STUDENTS ARE ADMITTED AS BOARDERS. Only authorized Parents / Guardians will be allowed to meet their ward on specified 2nd Saturday
Please state names of Parents/Guardians who can visit the ward:
***School will not take responsibility if any of the visitors mentioned here are involved withany illegal acts with students during visitation.
1st Name of Parent/Guardian for visitation
First Name
Last Name
2nd Name of Parent/Guardian for visitation
First Name
Last Name
3rd Name of Parent/Guardian for visitation
First Name
Last Name
Declaration:
I do hereby declare that the statements furnished above are true to the best of my knowledge and belief. If found false my admission may be cancelled without prior information by the school authorities. I promise to abide by the rules and regulations of the school and Hostel, failing to do so may result in my expulsion from the school.
I Declare (Student)
Signature of Parent
Documents to be attached:
***Other documents (marksheet, transfer certificate, CR) to be submitted once official admission begins. Please await email right after NBSE results are declared.
Admit Card
*
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STUDENT'S BANK PASS BOOK (STUDENT'S BANK ACCOUNT NO. FROM NATIONALIZED BANK FOR SCHOLARSHIP) IF THE STUDENT DOES NOT HAVE IT, IT WILL BE REQUIRED TO SUBMIT LATER ONCE ADMISSIONS ARE DONE.
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STUDENT AADHAR CARD
*
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Student's Medical History Form:
***THERE IS TWO MEDICAL HISTORY SECTION: CURRENTLY HAVE & PREVIOUSLY HAD(PLEASE LOOK CAREFULLY AND CHOOSE, IF NOT ANY IN THE LIST THERE IS ANOTHER OPTION TO TYPE IN WHAT YOU HAVE OR HAD)
PERSONAL HEALTH HISTORY (CURRENTLY HAVE) PLEASE SELECT THE OPTIONS FROM BELOW:
Chicken pox
Measles
Asthma
Chronic cough
Mumps
Chest pain
Polio
Heart Problem
Whooping cough
High blood pressure
Hepatitis (jaundice)
Bleeds excessively after injury
Malaria
Appendicitis
Tuberculosis
Abdominal pain
Typhoid
Bladder infection
Frequent common cold
Diarrhea/dysentery
Frequent earache
Gallbladder pain/stone
Frequent nose bleeding
Frequent indigestion
Frequent sore throat
Hernia
Tonsillitis
Kidney infection
Tooth/Gum problem
Depression
Frequent boils
Drug Habit
Scabies
Hysteria
Epilepsy
Mental illness
Dizziness/Fainting
Smoking/Tobacco habit
Frequent Headache
* Allergy to any kind of medicine
Sleep walking
Liver Enlargement
Eye pain/infection
Eczema
Student has none of the above
Other
ADDITIONAL INFORMATION(INCLUDING ANY MEDICATION)
*** Compulsory: All students must test for Tuberculosis (TB) and submit a Negative Report before paying admission fees.
If T.B test done then please submit here a digital copy
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*** Any information that has been withheld or forged, may lead to a student's expulsion.***** YOU WILL NEED TO GET A SIGN AND STAMP ON THE MEDICAL HISTORY FORM WITH NAME OF DOCTOR, PRACTICING HOSPITAL, SIGN AND STAMP OF DOCTOR WITH DATE. YOU CAN PRINT THE MEDICAL FORM GIVEN ABOVE OR COLLECT ONE FROM OFFICE.
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Admission Form and Prospectus
Price of Admission Form and Prospectus. Prospectus can be emailed to you or you can collect from office
$
400.00
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