5/8/2015 Intermediate Application Form

http://www.sxconline.org.in/FormsOnline/sxcinter/sxcInterForms.aspx?subbrid=40&crId=17&crtypId=1 1/3

* Marked with (*) are mandatory. 40

* Don't refresh the page during fi l l ing form.

* (Your appl ication wi l l be regis tred only after the payment of appl ication money to United Bank of India .)

Payment & Course Details

Bank Transaction No. : AA69545 Date of Payment : 06/05/2015 Amount : 600

Course : I.A. Session : 15-17 Stream : NA

Upload Photo Photo Size (3x3 cm or 85x85 px) only in .jpg, .gif, .png format (Photo Upload is Mandatory)

SELECT PHOTO : No file chosenChoose FileBrowse & Click here to UploadPhoto

Personal Details * Required fields (All details as per in your Matriculation Certificate)

*Applicant Name :

*Applicant Name Hindi : Type your name in English and press spacebar.

*Father's Guardian's Name :

*Mother's Name :

*Marks of Identification

Aadhaar No (UID) :

*Date of Birth : (dd-MM-yyyy)

*Birth Place :

*Applicant State : STATE

*Marital Status : MARITAL STATUS

*Category : CATEGORY

*Sub Category : SUB-CATEGORY

*Gender : GENDER

*Blood Group : BLOOD GROUP

*Religion : SELECT RELIGION

Phone (LL) :

*Mobile :

Email :

*Economic Status : ECONOMIC STATUS

*Mother Tongue :

*Locality : LOCALITY

*Nationality : INDIAN

Parents/Guardian Details * Optional (Provide Only Correct Information if Applicable)Father's/Guardian's Details

Is your Father an old student ofthis College

: NO Is he a member of AROX : NO Occupation : OCCUPATION

Designation : Phone No : Mobile :

Email : Qualification :

Mother's Details

Is your Mother an old studentof this College

: NO Is she a member of AROX : NO Occupation : OCCUPATION

Designation : Phone No : Mobile :

Email : Qualification :

5/8/2015 Intermediate Application Form

http://www.sxconline.org.in/FormsOnline/sxcinter/sxcInterForms.aspx?subbrid=40&crId=17&crtypId=1 2/3

Applicant Address * Provide Only Correct Information.Applicant Permanent Address Applicant Correspondence Address

* Permanent Address :

* City/District :

*State : STATE

*Pin/Zip Code :

Click If Both Address Is Same.

Correspondence Address :

City/District :

State : STATE

Pin/Zip Code :

Select Subject * All fields are mandatory in this section (Read carefully instructions in the Prospectus)

INTERMEDIATE (ARTS) FIRST YEARCOMPULSORY PAPER-I CORE

LANGUAGE*: ENGLISH

ELECTIVE LANGUAGES (ANY ONE)* : HINDI

OPTIONAL PAPER-I* : SELECT

OPTIONAL PAPER-II* :ECONOMICS

OPTIONAL PAPER-III* :POLITICAL SCIENCE

ADDITIONAL SUBJECTS (ANY ONE)* : SELECT

Academic Record * All fields are mandatory in this section

PASSED MATRIC/ICSC/CBSE DETAILS

EXAM NAME : MATRIC PASSING YEAR : 2015

BOARD : JAC DIVISION/GRADE : DIV

NAME OF SCHOOL : STATE : JHARKHAND

REGISTRATION NO : MEDIUM : SELECT

MARKS DETAILS (JAC/CBSE/ICSE) BOARDMARKS CONSIDER FOR ONLY LANGUAGEI,LANGUAGEII,MATH,SC,SO.SC SUBJECT'S ( DON'T ADD ADDITIONAL SUBJECT MARKS IN OUT OF TOTAL MARKS* NOTE: FOR CBSE CANDIDATE IF HAVING ONLY GRADE THEN SELECT ONLY GRADE.

PAPER SUBJECT ONLY FOR CBSE ONLY FOR JAC/ICSE/OTHERS

LANGUAGE-I : ENGLISH GRADE : GRADE MARKS : 00

LANGUAGE-II : HINDI GRADE : GRADE MARKS : 00

OTHER SUBJECT-I : MATH GRADE : GRADE MARKS : 00

OTHER SUBJECT-II : SCIENCE (PHY,CHE,BIO) GRADE : GRADE MARKS : 00

OTHER SUBJECT-III :SOCIAL SCIENCE (HIS,GEO,CIV)

GRADE : GRADE MARKS : 00

OUT OF (EXAM TOTALMARKS) i.e 500.

: 500 PERCENTAGE OFTOTAL MARKS

: % TOTAL MARKS :

Other Details * Provide only correct information.

1 : If Physically Challenged. : NO

2 :If yes specify the detais parts of physical disabilities& percentage

:

3 : Son/Daughter of Ex-servicemen. NO

4 : Conveyance if any, used to come college. : NO If yes Keep always driving licence & parking pass with you.

5 : Other Examination/Course or studies taken. :

6 : Extra Activities :

7 : Skill Level : NO

* This field is required

5/8/2015 Intermediate Application Form

http://www.sxconline.org.in/FormsOnline/sxcinter/sxcInterForms.aspx?subbrid=40&crId=17&crtypId=1 3/3

Undertaking

1 :I hereby to abide by the College and Jharkhand Intermediate Education Council Rules regarding attendance, viz., that if my attendance isfound to be unsatisfactory, I shall not be promoted/permitted to next higher classes/Examination.

2 : I am aware of the Rules and Laws regarding ragging. Ragging is strictly prohibited.It is a punishable offence.

3 :I hereby accept the College Privacy that students with serious complaints of indiscipline against them, will not be readmitted/promoted tothe next higher class.

4 : I am ready to accept the college policy on leave/college functions/eductional activities.

5 :A Student will not be granted promotion unless:i. He/She has attended at least 75% of the lectures and 75% of Practicals.ii. His/Her performance at the semester examination is satisfactory.

I declare that all the above mentioned information is correct & true and I will abide by all Rules and Regulations of the College andaccept the decision of the Principal in all matters as final.

Submit

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