City / State                                                                    Country                                                      Pin

Have you ever applied for admission at any of the G.D.Goenka Public School          Yes                                   No

Details of the boarding facilities required                                                               Day-Boarding                     Full-Boarding

Surname                                       First Name                                                  Middle Name                            

Date of Birth                                  Gender                                                       Nationality                                 

Mother tongue                                                                          Language spoken in home

Father’s Name                                                    Age                                      Nationality

Educational Qualification                                                                                 Occupation

Mother’s Name                                                   Age                                      Nationality

Educational Qualification                                                                                 Occupation

Name of the present school    

City / State                                                      Country      

From                                                               To                        

Name of any previous school attended

City / State                                                      Country    

From                                                               To                                                     

Reason for leaving the present school  

Residence Address

Home Telephone                                                            Fax

Mobile                                                                           Mobile 2  

E-mail  

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Seeking Admission for :

Student Personal Details :

Educational Information :

Contact Information :

I / We Are considering enrolment In Grade /Class                        Stream (Applicable for Class XI & XII Only)                       

with effect from                                                   month / year

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