के न्द्रीय विद्यालय क्रमाांक 6, भुबनेश्वर
KENDRIYA VIDYALAYA CHAMERA NO.6, POKHARIPUT, BHUBANESWAR
REGISTRATION CUM OPTION FORM FOR CLASS XI 2023-2024
(Admission Subject to availability of seats as per KVS Admission Guidelines 2023-2024)
Registration No. ___________ Science (For Office use only)
1. a. Name of the Student: ________________________________
b. Name of School : ________________________________ Affix your recent
2. Class and Section in which studied in 2021-2022: ____________ colored passport
3. CBSE Roll No. of AISSE- 2023: ____________________________ size photo
4. Date of Birth: ______/_____/____________
5. Social Category (SC / ST / OBC / General): _________________
6. Result of AISSE 2022-2023: ________
Subjects English Hindi Maths Science S.Sc. Percentage
Marks
7.
Participation in 2022-2023 : (Attach photocopy of certificates) Yes/No Annex. No. Participation in
a) Games & Sports-SGFI /National/ Regional / District level
b) Scouting & Guiding- Rashtrapati / Rajya / Tritya Sopan with 5 Badges
c) Adventure activities-At least one of 10 days (If any)
d) NCC-‘A’ Certificate with participation in Republic /PM Rally
e) NCC-‘A’ Certificate with / without best Cadet in Distt/State level
8. Aggregate of percentage (Add 5+6+7): __________________________ (To be filled by KV RRC Office)
9. Read the available combination of subjects for each stream, then fill the options:
SN Available options/ COMPULSORY SUBJECTS(Four for stream) One optional 6th Subject
Streams (to be filled)
1. Science with Math English Physics Chemistry Math Bio Physical
and BIo Education
2. Science with Maths and English Physics Chemistry Maths Comp. Sci. Physical
C.S Education
3. Science with Bio and English Physics Chemistry Bio HIndi Physical
Hindi Education
Write the preferences of strreams and one optional subject of respective choice
SN Choice no. NAME of Option
1 1st Choice
2 2nd Choice
3 3rd Choice
10. Residential Address: _____________________________________________________________________________________
11. Permanent Address: _____________________________________________________________________________________
12. Service Category_____________________
Cat-1 Central government permanent employee
Cat: 2 Employee Autonomous departments under central govt.
Cat: 3 State government permanent employee
Cat: 4 Employee Autonomous departments under state govt.
Cat: 5 Private job, business, farming, other work
(Attach Service certificate issued by competent authority or office for Govt employees only)
Important to Note:
1. Stream & Subject once opted cannot be changed.
2. Registration cum option from is to be submitted along with photocopy of marks statement and other relevant supporting
documents including caste certificate (if any) as later neither social category nor merit position will be altered.
3. Incomplete form will be summarily rejected.
For Students and their Parents :
Stream will be allotted as per following merit :
First lot of students (Higher to lower ) as per merit list – Science with Mathematics.
Second lot of students ( Higher to lower ) as per merit list- Science without Maths.
For Non KV Students :
1. Science Stream as per the merit list if vacancy exists after taking KVs students
**(A)The following concession will be granted to students for admission who participated in Games & Sports meet/
Scouting & Guiding/NCC/Adventure activities at various levels. The certificate needed for this purpose can be of any of
the preceding years.
Declaration
I hereby declare that all the information given above is true and correct to the best of my
Knowledge and give an undertaking that I shall abide by the rules & regulation of the Vidyalaya
and will maintain perfect discipline in the Vidyalaya.
Signature Name Contact no.
Father ……….……………………………. ….……………………………………. …...………………………………..
Mother ……………………………………….. …...………………………………..
Student ……….……………………………. ….……………………………………. …...…………………………………
Report of Admission Committee
Admission Of Master/Ms …………………………………………………………………………….Son / Daughter of Shri ……………………………………..
……………………………………………………… having contact no. ……………….……………………………………….. in class XI Science with Maths
& Bio/Science with maths & C.S / Science with Biology & Hindi is recommended.
Signature of Checker Signature of I/C admission Signature of principal
