[AFFILIATED TO THE CENTRAL BOARD OF SECONDARY EDUCATION, NEW DELHI]AFFILIATION NO.- 1530009

(A Unit of B. J. Education Society)M-15, BJB Nagar, Bhubaneswar- 751 014

Phone: +91-674-2310457 / 2310442, 2314040 (Primary Block)E-mail: bjemschool.100@rediffmail.com, Website : www.bjemschool.org

S . CHM. OE. OJ. L

B

PROSPECTUS

BUXI JAGABANDHU ENGLISH MEDIUM SCHOOLBUXI JAGABANDHU ENGLISH MEDIUM SCHOOL

Buxi Jagabandhu English Medium School, an institute par

excellence, has carved a niche for itself in a remarkable journey of

41 years. The school has acquired this position by remaining true to

its commitment of providing value -based education and keeping

abreast with the changes in the society to prepare the students to

face the future challenges, both as leaders and individuals. The

achievements of the students in the State and National Level,

besides the superb academic results in the Board examinations year

after year substantiate its stand.

Our endeavour is to provide a student-friendly

environment, to nurture the individuality and personality of the

children; to encourage them to learn; and to inculcate in them the

spirit of friendship, equality, discipline, human values and

inquisitiveness.

Our infrastructure and facilities provided to the students

and staff are constantly upgraded. Our aim is not just to impart

bookish knowledge to qualify in a test. We always endeavour to

instill in our students, the skill to internalize the knowledge gained

in the class room so as to face life with courage and determination,

excel in future studies and thereby land in a brilliant career and

ultimately become worthy citizens of the country.

Our objective has been to empower ourselves incessantly

with the emerging pedagogic tools and to remain steadfast to our

guiding principle ‘Let learning be a joy and teaching a pleasure’.

Ms. Sandhya JenaPrincipal

Let Learning be a joy and

teaching a pleasure

Buxi Jagabandhu English Medium School was established by Buxi Jagabandhu Education

Society consisting of a few renowned, committed philanthropists, educationists and social

activists of the locality called B.J.B. Nagar, in the temple city of Bhubaneswar. The school has been

named after Buxi Jagabandhu Bidyadhar Bhramarbar Ray, an eminent freedom fighter of Odisha. thThe School came into existence on 15 January 1974 with a modest beginning of 25 students and

one teacher. Now it has grown to a remarkable height and is considered to be one of the premier

Senior Secondary Educational Institutions of the State. It is affiliated to the Central Board of

Secondary Education (CBSE), New Delhi.

The Motto of the School is mee efJeÐee ³ee efJecegkeÌle³es (SA VIDYA YA VIMUKTAYE) and its guiding

principle is “Let Learning be a Joy and Teaching a Pleasure”.

Over the years the school has developed a huge educational infrastructure for classes from

Lower Nursery to Class XII (Science and Commerce) with the best possible facilities and provisions

to cater the present and latest requirements of more than 3,400 students and 140 teachers. It

extends all possible care to nurture the hidden talents of its learners. The School has been

functioning successfully with the concerted efforts of the Management, the efficient & experienced

Principal, the learned faculty and responsible parents.

A four storeyed building has been built as an extension block for the Pre- Nursery to thStandard III, to extreme left of the main building. The block opened its doors on 16 June, 2004 and

has been running very successfully.

It accommodates classes from Lower Nursery to Std. III in two shifts. It has wonderfully

painted airy classrooms and nicely decorated toy rooms with audio-video facilities for the tiny tots.

It has a well-equipped, spacious Reading Hall to facilitate the students and teachers as well. A

beautiful mini garden and an accomodious assembly ground add to the beauty of its ambience.

Latest educational techniques are implemented to make learning stress free and an enjoyable

experience for the young inmates.

The school has added a multi storeyed +2 (Science & Commerce) block for the students of

Class XI & XII with well equipped modern facilities.

The school aims at promotion of quality education and an all round development in

personality of a child so as to enable him/ her to be a responsible citizen of tomorrow.

THE SCHOOL AT A GLANCETHE SCHOOL AT A GLANCE

GOALS AND DIRECTIVES

THE EDUCATIONAL ENVIRONMENT

The school curriculum is designed to help each child to reach his/ her full potential by

providing a wide general education, encouraging community spirit and sense of responsibility.

Education at B.J.E.M. School is rooted in the belief that the student must be an active participant in

the educational process. The school aims at helping the child to develop every facet of his / her

personality - physical, intellectual, emotional and spiritual. Our efforts are directed at preparing

the students to be disciplined, fearless, courteous and well informed human beings in this rapidly

changing world.

We believe that ...

1. The child is the pivot of all our programmes and policies. There is no place for any form of

corporal punishment. We affirm the importance of personality, identity and individuality of

every child.

2. The School endeavors to inculcate in each child, the pride of being an Indian, and love for the

cultural heritage of India. Our aim is to inspire our children to respect the national traditions,

values and ideals.

3. Every child can develop fully, only if he/ she is proficient in his/ her mother tongue. Though

the medium of instruction is English, the mother tongue of the child is given much

importance to enable him/ her to understand and appreciate the ethnic culture of the state

and nation as well for which Odia has been made available as an optional subject.

4. All efforts are made to establish an open environment in the school administration. A strong

and active S.M.C., parents and our alumni strengthen the hands of the authorities in

motivating and inspiring the staff and students alike.

5. The faculty of the school has academic freedom to function effectively. Regular in-service

teacher’s training programmes orient the staff with the most modern techniques in the field

of education.

Our educational programme is constantly monitored and improved. The facilities are being

further developed. The objective is to enable the students not only to gain entry to reputed

institutions but to understand how the skills gained can be used for future studies, career making

and above all to become a good human being.

OBJECTIVESOBJECTIVES

During the two years of pre-school education, children explore and understand the physical world

around them through various play way methods. Special emphasis is laid on muscular

development, co-ordination of hand and eye, control of limbs, sensory perceptions and social

skills.

As per the recommendation of the Ministry of Human Resource Development, Govt. of

India and under the CBSE guidelines the School has introduced Continuous and Comprehensive

Evaluation (CCE) system for its students from Std.-I to Std.- X which will lead to diagnosis,

remediation and enhancement of learning.

The system with two fold objectives like ‘Continuous’ i.e. for continuity in evaluation and

assessment of board based learning and behavioural outcomes emphasises evaluation of

identified aspects of students, built into the total teaching-learning process spread over the entire

span of academic session in one hand and on the other hand ‘Comprehensive’ to cover both the

scholastic and co-scholastic aspects of students growth and development including Life skills,

Attitude and Values, literary & Creative skills, Scientific skills, Aesthetic & Performing Arts,

Organisational & Leadership skills, Information & Communication Technology, Physical & Health

Education.

Our School has been awarded with the tagline “CBSE New Generation Schools” which gives

the school a separate identity from the other schools. Our school now offers NVEQF based

vocational course namely I.T. at Secondary level.

In order to enhance the academic excellence of the school, Digital Smart Class has been introduced

in the school from the session 2013-14 (Class V-X). The Class rooms from St.- I to IV will be

equipped with digital smart board from the coming session. Tata class edge, a subsidiary of Tata

Group with a nation wide reputation is managing the logistics and operations of the Digital Smart

Class.

Timely special coaching in two rounds is provided to the students for National Talent

Search examination (NTSE) for class X making the best of this kind available by engaging experts of

school as well as of the capital city. A record number of students qualify every year, and place

themselves as National Talent Search Examination Scholars in the country.

CBSE NEW GENERATION SCHOOLS

DIGITAL SMART CLASS

SPECIALISED ACADEMIC ASSISTANCE

THE ACADEMIC PROGRAMMETHE ACADEMIC PROGRAMME

“SOFT SKILLS” DEVELOPMENT PROGRAMME :

AUDIO -VISUAL AIDS

COMPUTER CENTRE

LIBRARY

A soft skills development programme is being pursued by the school for the last seven

years. Special compulsory classes are held every week in which students participate in various

activity modules like - Debates, Elocutions, Extempore speeches, JAM, Panel/ Group Discussions,

story telling / enactment, Recitation, Conversations (Telephonic / General) Mock Interviews, Quiz,

News Reporting, Commentaries, Dramatics and many more.

Three Soft Skill Trainers are in charge of this programme which embraces all the sections

from Std I to IX. This value based programme aims at enhancing the students’ communication

skills, which gives vent to their creative abilities and taps their latent talents. This pioneering effort

has helped in producing a confident, skillful, positive and vivacious crop of BJEM students.

The school has an Audio Room and a slide projector, an overhead projector, tape recorders,

colour television, VCR, computers with multimedia and internet facilities, etc. to enhance the

effectiveness of teaching learning process.

The introduction of computer in school has become an integral part of education. Our air

conditioned computer Lab-I & II have adequate number of computers with Multimedia and

Internet facilities. Computer courses are available for students from Std. IV onwards as a part of the

SUPW programme of CBSE syllabus.

From session 1999-2000 onwards, Computer Science has been introduced as one of the

optional subjects in Science stream as an alternative to Biology in Class XI & XII. The School

accounts, examination results, directories of staff and parents and student profiles have been

computerised.

Our school has a well stocked library, staffed adequately to keep the library in good order,

and to guide the students during their library periods to make best use of the library and the books.

The stock is constantly expanded and updated to provide meaningful reference material to

students and teachers.

All have access to the library, which follows the Dewey system of classification.

There is a special section ‘oversight book’ for the use of the students of Std. X, XI and XII.

This section contains supplementary reading materials like parallel textbooks, reference books,

maps and examination papers of previous years.

There is a special section for teachers. There is also a video Film Library of informative and

educational films, catering to the needs of different age groups.

LABORATORIES

STUDENTS PARTICIPATION :

CO-CURRICULAR & EXTRA CURRICULAR ACTIVITIES

The school has well equipped laboratories in Physics, Chemistry, Biology, Mathematics,

Computer Science, Social Science with comfortable infrastructure and instruments for 40

students at the same time. These are well maintained by experienced assistants supported by

attendants.

The school also has a well equipped English Language laboratory with modern

instruments such as audio visual aids, computer etc. to deal with the listening and speaking

aspects of the curriculum.

The school is quite alive to its responsibility of inculcating leadership qualities among the

students. The students are trained to shoulder positions of responsibility. There are school

appointments, house appointments, class appointments etc. The class monitors perform duties

assigned to them by the class teachers. School prefects and House prefects work in the various

school committees, hold periodical meetings and suggest the Principal about the welfare

measures to be taken for the student Community. The Head Boy, The Head Girl, the Team and

House Captains and the other prefects are appointed by the Principal amongst those who show

qualities of leadership and command a great deal of respect from their fellow students, and form a

very valuable part of the school community.

An array of extra curricular and co-curricular activities complement the academic courses

to enrich the life of the school community and to help the students develop physically, emotionally,

and socially.

Physical Education is given as much importance as academics. Pupils are provided with

ample opportunities to play a wide variety of games, both indoor and outdoor, during the school

hours as per the provision in time table and beyond the school hours for special skills under the

supervision of trained PETs and coaches appointed for the purpose.

The Student Community from Lower Nursery to Std.- XII is divided into six Houses namely

‘Abhimanyu, Arjuna, Dhruva, Ekalavya, Karna & Shravan’. Each house has a captain and a vice-

captain and the faculty act as House co-ordinators & Deputy Co-ordinators and look after the

general progress of the house in various areas. Since all activities are held on House-basis, House

loyalty is the base of all achievements.

A regular record of students’ participation in intra and inter house activities is maintained

and points are awarded to the respective House, which contribute to determine the champion

house at the end of the year.

The Annual Inter-House Athletic and Sports Meet is organised and certificates of Merit,

medals and trophies are awarded to the worthy participants. In addition to this, Annual

Inter-House Tournaments are held in major games like Basket Ball, Volley Ball, Football,

Kho-Kho, Badminton etc.

Inter School Tournaments / Matches - Every year our students participate in various inter

school tournaments like, chess, football, cricket, basketball, Kho-Kho etc and have brought

laurels to our school.

Hobby Classes : Hobbies are a part of the curriculum for all the students of class LN to X.

Hobby classes in Fine Art and Craft, Outdoor & Indoor games, Dance and Music are offered to

the students of primary classes on working Saturdays of every month.

The school provides facilities of leisure time activities like Table Tennis, Carom, Chess,

Badminton, Foot Ball, Cricket, Basket Ball etc. Playgrounds are also equipped with swings, a

see-saw, jungle-Jimeti etc.

The School encourages and inspires the students to make the best use of their interest, skill,

time, energy and knowledge in making projects in Science, Social studies, Mathematics,

Languages, Art & Craft and Games & Sports. An Inter disciplinary Exhibition cum

Demonstration is held every year. Prizes and Awards are given away to the students for best

display and demonstration of their exhibits.

The school runs two active clubs- the Eco-club and the Heritage club which helps students to

develop their organisational & leadership skills through activities like study tours & trips,

exhibitions, projects, rallies and drives, film shows, group discussion, talks etc. Regular trips

are organised to the museums, Science Park, Reginal Science Centre, Planetarium, Botanical

Garden as a learning experience.

The school conducts the morning assembly daily in an exclusive manner. It is a congregation

of the staff and the students where, besides prayer and patriotic songs, relevant information

is passed to all concerned. The daily news headlines and school news are read out. Individual

speakers among the students and the teachers deliberate on various informative and

l

l

l

EXHIBITIONS AND DEMONSTRATIONS :

ECO CLUB & HERITAGE CLUB

SCHOOL ASSEMBLY

n

n

n

educative topics. Other activities include conversational English and open house quiz. This

fosters a competitive spirit and gives wide exposure to the students.

This also provides a platform to observe various important Days, as earmarked by the CBSE

or the government, to create awareness among the students about the significance of such

days or weeks.

The Annual day is celebrated in March/ April. Students participation in various colourful

cultural programmes is encouraged to give them a strong school feeling and to make them

feel responsible for bringing a good name to the school through the presentation of their

expertise.

The Annual Day also brings out the latent talent in the students and teachers and helps them

to be good hosts.

The school organises and encourages healthy competitive participation We endeavour to

adopt new methods of teaching and help the students communicate freely on all subjects.

BJEMS is an institution that encourages community living, in which teachers are friends,

philosophers and guides.

Our goal is to stimulate participation in cultural and intellectual endeavours towards the

development of the whole individual. BJEMS is a place where living, learning and socializing

are merged into one, providing maximum exposure for contact and interaction between the

students and the faculty.

BJEMS is a colourful heritage, a true synthesis of Indian heritage and western ideas. Here we

not only shape managers of the future but also aim at making complete individuals.

The school organises various State, National and International level Examinations and

Contests for the students from Primary to Senior Secondary level to give them a higher

competitive aptitude and attitude. Some of them are stated below.

International Mathematics Olympiad (IMO) National Science and Mathematics Olympiad

National Cyber Olympiad (NCO) Young Learners. English Test (YLE)

International Informatics Olympiad (IIO) All India Camel Colour Contest etc.

National Talent Search Examination (NTSE) National Science Talent Search Examination.

International English Olympiad (IEO) All Odisha Geography Talent Test.

n

n

n

ANNUAL DAY

COMPETITIONS

STATE & NATIONAL LEVEL EXAMINATIONS AND CONTESTS

v v

v v

v v

v v

v v

n

n

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AWARDS AND HONOURS

N.C.C.

SCOUT / GUIDE

RED CROSS

SOCIAL SERVICE LEAGUE

1The school has introduced an Award named ‘BJEM BLUE from the session 2003-04. One of

the students from class IX is awarded and honoured with the Title on the basis of extra

ordinary performances in the field of academics and extracurricular activities. In addition

to this, various Memorial Awards and Awards for Best Student, Best Scout & Guide, Best

N.C.C. Cadet (in Army, Air & Naval wings) boys & girls are given away to appreciate the

achievements of the students.

Students of Std. VIII with the motto, ‘Unity & Discipline’ opt for a two years’ training in

National Cadet Corps. They may enroll themselves in the Army wing for Boys and Girls or

the Air-wing for Boys and Navy wing for Boys and girls to remain available in all readiness

to be of any assistance to any individual/ administration at the time of need. Their

excellence enables them not only to be part of the state level parade and functions like

Independence Day, Republic Day, NCC Day etc. but also adjudged the ‘best cadet’ at the

national level.

Scouting & Guiding are optional for boys & girls of classes VI to X and in fact it makes the

students a complete person in all respects. Besides getting weightage during the

admission into colleges, it equips the students very well with various life skills

The main objectives of Junior Red Cross are :

I) Organising Health Projects.

ii) Service to others.

iii) Fostering of World Friendship.

The children of our school take active part in all such programmes and bring a difference to

their personal endeavours.

The Social Service league aims at helping those who are poor and needy and are connected

with the working of the school. It also helps those in the community, who sustain natural calamities

and need immediate help.

The underlying concept of the league is to inculcate compassion and generosity in the

student, so that each individual student learns to take pride in giving rather than taking. The

development of this single personality trait may revolutionise the mind of a child and encourage

him/ her to serve for the greater cause of humanity.

SCHOOL CANTEEN

SCHOOL BOOK SHOP

THE SCHOOL CLINIC

BANK FACILITY

SCHOOL CYCLE STAND

SCHOOL TIMINGS

ADMISSION AND WITHDRAWALADMISSION

The school Canteen serves delicious snacks, tea, soft drinks, etc. at reasonable price on cash payment during the break times.

The school books and other articles of stationery can be purchased from the school book shop which operates in the premises at the beginning of the new session. For the sake of uniformity, students are required to buy exercise books of the standard design bearing the name & logo of the school from the school book shop.

The school has a small but well equipped clinic under the care of a medical officer. First aid dressings for all kinds of wounds and sprains are done for the children. Once in a year, routine medical check up is carried out for all the children in the school besides the height weight measurements recorded at the term ends twice in a year.

There is a Bank Counter adjacent to the Administrative Block inside the school campus for

the smooth financial transactions of the school as well as of the students and parents.

The School has a permanent cycle stand. Students who want to keep their bicycles / bikes

deposit ̀ 360/- (@ 30/- per month) for bicycles and 600/- (@ 50/- per month) for bike at

the beginning of the new session at the school bank counter and obtain a yearly pass from the

school office. Daily coupons are issued at the time of entry on producing the yearly pass and

collected back at the time of dispersal.

Monday to Saturday

Lower Nursery & Upper Nursery - 06.45 a.m. to 10.00 a.m.

Std. I, II and III - 10.20 a.m. to 03.50 p.m.

Std. IV to X - 10.20 a.m. to 04.30 p.m.

Std. XI and XII - 07.15 a.m. to 01.20 p.m.

st1. An applicant must have completed Three Years as on 31 May of the year of Admission.

2. Applications in prescribed Forms are invited for Admission into LOWER NURSERY class of

the coming academic session. Prospectus alongwith Application Forms can be obtained

from the School Bank Counter as per the notice displayed on the School Notice Board in

between 10.00 a.m. to 2.00 p.m. on all working days i.e. from Monday to Saturday on payment

of Rs. 1000/-

3. The sale of text books for Lower Nursery will be intimated in due course.

` ` `

DOCUMENTS REQUIRED

GENERAL RULE

a) Transfer Certificate is not required for admission in Classes Nursery to Std. I. Only birth

certificate from the Municipality or Panchayat will be accepted.

b) Transfer Certificate from the previous school is a ‘must’ for admission to Std. II and above.

The school issuing such certificates should be recognised by the Government or Board.

The Certificate issued must be countersigned by the District Inspector of Schools or Circle

Inspector of School or the Director of Public Instruction of Schools.

c) Attested copies of mark sheet showing the performance of the student in the previous

class should be submitted along with the application.

d) Two stamp size colour photographs of the student.

e) Money receipt should be attached to the application form.

f) BPL, SEBC, SC, ST, photocopy of certificates should be attached to the application form

which must be obtained from Bhubaneswar jurisdictions only.

4. The School shall follow a system of random selection for Lower Nursery admission out of the

application received from children belonging to disadvantaged groups and weaker sections

for filling the pre-determined number of seats which should be not less than 25% of the

strength of the class. 15% of seats shall be filled up by the child belonging to disadvantaged

groups (BPL Card Holders, SC/ST, SEBC and children who are found without any home or any

settled place or abode and without any ostensible means of subsistence or a child who is

found begging or who is either a street child or a working child residing within 1 k.m.

distance from the school). The rest 10% of seats shall be filled up by children belonging to

weaker section. In case there is non availability of children of any of the above two

categories, there shall be inter change of seats.

For admission to the remaining seats, selection will be done on random basis. There shall be

no test or interviews for any child / parent falling within or out side the categories.

1. The school reserves the right to admit or reject any student without assigning any reason.

The decision of the Principal shall be abiding and final.

2. English is the medium of instruction right from Lower Nursery. Hindi and Odia are taught

from Std. - I onwards.

3. The enrolment form and the other necessary papers must be filled in with due care by

parent/ guardian. The name and date of birth of the student once recorded in the enrolment

form and school admission register cannot be changed later. An undertaking to this effect

will have to be signed with the enrolment form.

WITHDRAWAL

MODE OF PAYMENT

July : The defaulters shall have to pay a fine of one month’s tuition fee starting

from 1st July along with the arrears.

1. The Principal reserves the right to ask for the withdrawal of any student who has proved

immune to correction.

2. Request for the withdrawal of a pupil must be made in writing by his / her parents

accompanied by a remittance of requisite fees for the issue of the School Leaving Certificate /

T.C.

3. All the dues have to be cleared before a School Leaving Certificate is issued. No question of

refund of any dues of a child will arise at the time of withdrawal after getting

admission into any class.

4. The student shall be suspended or expelled from the school on the following grounds.

a) Indiscipline, assaulting fellow students, mishandling school appliances, carrying/

bursting crackers, stealing and leaving the school without permission during the school

hours.

b) Non payment of dues

c) On failing twice in the same class

d) At any time, if the authorities are satisfied that such withdrawal is necessary in the

interest of the school.

e) The name of the student will be struck off the rolls after continuous absence for ten days

without information. He/ she may be readmitted as per rules and the discretion of the

Principal. Students are required to secure 75% of the total attendance during a session to

be eligible to appear in their final examination.

f) The decision of the Principal shall be final and binding in this regard.

Payment should be made in the Odisha Gramya Bank Extension Counter of B. J. E.M. School,

on all Bank working days from 10.00 A.M. to 2.00 P.M.

All the fees are to be paid in cash only, not in cheque or draft. The tuition fees for any

month can be paid on or before 15th of the same month without fine.thA fine of Rs. 10/- will be charged from defaulters after 15 till the end of the month. A fine of

Rs. 20/- will be charged if the School fees are paid within the next month and Rs. 30/- if paid within

two months (see the example below for the month of April).

April 1st to 15th No fine

April 16th to 30th Rs. 10/-

May (whole month) Rs. 20/-

June (whole month) Rs. 30/-

All the fees will be accepted at School Bank Counter in between 10.00 a.m. to 2.00 pm.

Monday to Saturday).

CLASS DATE OF THE MONTH

Lower Nursery 2nd

Upper Nursery 3rd

Std. I 4th

Std. II 5th

Std. III 6th

Std. IV to VII 7th

Std. VIII to X 9th

If any of the above mentioned date happens to be a scheduled holiday, the fee will be

accepted on the next working day.

The fees are payable for all the 12 months of the session for all classes.

1. Fee card must be produced at the counter for every payment. Please ensure that the

necessary entries are duly filled, in the fee card by the Bank at the counter after every

payment.

2. Duplicate fee card will be issued on payment of Rs. 30/-

3. Read the rules and guidelines printed on the fee card.

Students’ Safety Insurance Policy of the New India Assurance Company Limited has been

introduced by this institution in consultation with the above Insurance Company, for which a sum

of Rs. 3/- is payable by each student towards premium along with the dues of April every year.

The Diary is to be carried to school everyday. It is as good as an entry pass. It is to be used by the

pupils, teachers and parents. Important information, Notices, Practice assignments / HW given

etc. are to be noted down regularly by the students. Parents are required to go through their child’s

school diary regularly as it establishes a strong communication link between the teachers and the

parents, with regard to the quality of work being done by the students, both in school and at home.

Principal

B.J.E.M. School, Bhubaneswar

FEE CARD

STUDENTS’ SAFETY INSURANCE SCHEME

STUDENT’S DIARY

HOUSE T-SHIRT SPECIFICATIONS

A B H I M A N Y U RED

A R J U N A ORANGE

D H R U V A YELLOW

E K A L A B Y A MAUVE

K A R N A GREEN

S H R A V A N R. BLUE

pocket

Name of the House T-Shirt Colour Name of the House T-Shirt Colour

BU

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No.

Index

No.

Sch

ool R

egd. N

o. (

to b

e fi

lled u

p b

y offic

e)

:

1.

Nam

e o

f th

e A

pplic

ant

:(I

n C

apita

l Letters

)

2.

Gender

:B

oy

G

irl

3.

Cla

ss in w

hic

h a

dm

issi

on is

required

:

4.

a)

Date

of

Birth

i) in F

igure

:D

D

MM

Y

Y

ii)In

Word

s:

Attach

attest

ed c

opy

of B

irth

cert

ifica

te (

only

for

L.N

. , U

.N., S

td-I

)

(b)

Age a

s on 3

1st

May

of th

e:

Years

Month

s D

ays

5.

Blo

od G

roup

:

6.

Moth

er

Tongue

:

7.

a)

Odia

/ S

ansk

rit

:

(To b

e o

pte

d a

s th

e th

ird L

anguage fo

r C

lass

es

VI t

o V

III)

b)

Hin

di /

Odia

/ S

ansk

rit

:

(To b

e o

pte

d a

s th

e s

eco

nd la

nguage for

Cla

sses

IX to X

)8.

DE

TAIL

INF

OR

MA

TIO

N O

F P

AR

EN

TS

:

FAT

HE

RM

OT

HE

R(a

)N

am

e

(b)

Qu

alif

ica

tio

n

(c)

Occ

upatio

n

(d)

Desi

gnatio

n

(e)

Annual In

com

e

(f)

Nam

e o

f th

e D

ept. /

Offic

e

(g)

Tele

phone N

os.

Off

....

....

....

....

....

. R

es.

....

....

....

....

....

.O

ff..

....

....

....

....

...

Re

s.

....

....

....

...

Mo

b :

....

....

....

....

....

....

....

....

....

....

....

...M

ob :

....

....

....

....

....

....

....

....

....

....

.

e-m

ail.

....

....

....

....

....

....

....

....

....

....

....

e-m

ail.

....

....

....

....

....

....

....

....

....

...

9.

(A)

Pre

sent R

esi

dentia

l Addre

ss (at B

hubanesw

ar)

(B)

Perm

anent A

ddre

ssP

lot

No.

/ H

ouse

No:......................................

At

:...

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

..A

t:.

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

P.O

.:.

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

P.O

.:

....

....

....

....

....

....

....

....

....

....

....

....

....

....

..D

ist.

:...

....

....

....

....

....

....

....

Sta

te :

....

....

....

....

....

....

....

Dis

t:.

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

PIN

:...

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

..P

IN:.

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

10.

Does

the P

upil

have

any

chro

nic

/ s

erious

illness

?:Y

es

No

(Ple

ase

giv

e d

eta

ils if

he /

she h

as

any)

:

.

................................................................

.....

11.

Does

the P

upil

have

any

identif

ied a

llerg

ies

?: Ye

s

No

Ple

ase

giv

e d

eta

ils, i

f any

B.J

.E.M

. SC

HO

OL

, BH

UB

AN

ES

WA

R-1

4A

CK

NO

WL

ED

GE

ME

NT

RE

CE

IPT

(To b

e fill

ed in

by

pare

nt exc

ept In

dex

No.)

Ind

ex

No

.:..

....

....

....

....

....

....

....

.. N

am

e o

f th

e S

tud

en

t...

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

...

Cla

ss :

.................................... D

ate

of

rece

ipt

:.............................................

Receiv

ing

Off

icer

Sta

mp S

ize

Photo

gra

ph

INC

OM

PL

ET

E A

PP

LIC

AT

ION

FO

RM

IN A

NY

RE

SP

EC

T W

ILL

NO

T B

E E

NT

ER

TAIN

ED

year

of A

dm

issi

on

12.

Reco

rd o

f Pre

vious

educa

tion

:..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

...

(Encl

ose

true c

opy

of c

ert

ific

ate

)13.

a)

Hobby

b)

Specia

l in

tere

st

in a

ctivi

ties.

Put

( ü)

mark

again

st y

our

choic

e

Gam

es

Sport

s

Musi

c D

ance

A

rt

C

om

pute

r

Ext

ra C

urr

icula

r A

ctiv

ities

14.

Sib

ling (

child

ren o

f sam

e p

are

nts

readin

g in t

he S

chool)

a)

Tic

k th

e a

ppro

priate

box

:Ye

s N

o

b)If Y

ES

Sib

lings

Nam

e:

Cla

ss &

Sect

ion

:

(attach p

hoto

copy o

f cert

ifica

te)

15.

School A

lum

ni (

Tic

k th

e a

ppro

priate

):

I

f Ye

s, Y

ear

of

Pass

ing

(a f

orm

er

pupil

of

the s

chool)

a)

Fath

er

:Ye

s N

o

b)

Moth

er

:Ye

s N

o.

(Attach

Photo

copy

of passo

ut ce

rtifi

cate

of la

st c

lass

attended)

eith

er

of fa

ther

or

moth

er.

16.

Is t

he a

pplic

ant

a s

ingle

girl child

of

the p

are

nts

?:

Yes

No

17.

Does

the a

pplic

ant h

ave a

sis

ter (w

ithout b

roth

er)

:Ye

s

No

18.

Cate

gory

– th

e a

pplic

ant b

elo

ngs to

:S

C S

T O

BC

Diff

eren

tly a

bled

Gen

eral

B

PL

SE

BC

A c

hild

who

is fo

und

with

out a

ny h

ome

or a

ny s

ettle

d pl

ace

or a

bode

and

with

out a

ny o

sten

sibl

e m

eans

of s

ubsi

sten

ce

A c

hild

who is

found b

eggin

g o

r w

ho is

eith

er a s

treet c

hild

or

a w

ork

ing c

hild

(Attach

ed a

ttest

ed c

opy

of

cert

ifica

tes)

19.

Is the a

pplic

ant a s

taff c

hild

. (P

ut tic

k m

ark

):Ye

s N

o

(If

yes,

ple

ase

giv

e d

eta

ils)

:..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

...

20.

Nam

e t

wo p

ers

ons

mentionin

g t

heir r

ela

tionsh

ip: 1

)

with t

he a

pplic

ant

who w

ill v

isit t

he c

hild

: 2

)

21.

Mode o

f Tra

nsp

ort

, S

chool B

us/

Ow

n A

rrangem

ent

:

22.

Applic

atio

n f

ee R

eceip

t N

o.

& D

ate

:N

o.

Date

(Ple

ase a

ttach M

oney R

ece

ipt)

I/ W

e c

ert

ify t

hat

the info

rmation f

urn

ished a

bove

is

true t

o t

he b

est

of

my

/ our

know

ledge.

Full

Sig

natu

re o

f th

e F

ath

er

:F

ull

Sig

natu

re o

f th

e M

oth

er

:S

ignatu

re o

f th

e a

pplic

ant

Full

Sig

natu

re o

f th

e G

uard

ian

:(F

or

Std

. -

I and a

bove

)

UN

DE

RTA

KIN

G B

Y T

HE

PA

RE

NT

We,

Sri.

......

......

......

......

......

......

......

......

......

......

......

......

......

& S

mt..

......

......

......

......

......

......

......

......

......

......

......

. Par

ents

of o

ur s

on/ d

augh

ter

Sri/

Kum

ari .

......

......

......

......

......

......

......

......

......

....

of c

lass

.....

......

......

......

......

......

....

do h

ereb

y de

clar

e th

at w

e sh

all a

bide

by

the

rule

s of

the

inst

itutio

n. W

e do

her

eby

unde

rtak

e to

with

draw

our

chi

ld in

the

grea

ter

inte

rest

of t

he S

choo

l in

case

he

/ she

vio

late

s th

e ru

les.

The

dat

e of

birt

h an

d na

me

ente

red

by u

s in

the

appl

icat

ion

form

is fi

nal.

We

shal

l not

app

ly fo

r an

y ch

ange

in it

at a

ny ti

me

in fu

ture

.D

ate

: .

.........................

Pla

ce :

....

....

....

....

....

....

..S

ign

atu

re o

f th

e M

oth

er

Sig

natu

re o

f th

e F

ath

er

FO

R O

FF

ICE

US

E O

NLY

Adm

itted i

nto

cla

ss .

...............................................

Sect

ion .

.............................. S

chool

Regd.

No.

.......................

Ve

rifie

d b

y .

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.S

ignatu

re o

f th

e O

ffic

e A

ssis

tant

Sig

natu

re o

f th

e P

rinci

pal

with

date

with

date

Off

ice A

ssis

tan

tF

ile