Two years integrated Coaching Form

For class 10th students moving to class 11th

Student Information

Registration only for girls

Please enter your name as it appears on any government approved photo ID such as aadhar card, PAN, school admit card, DOB certificate, etc

Mode of Exam*

Offline (Students from Jharkhand only)

Online (Students outside Jharkhand only)

First Name*

Middle Name

Last Name*

Gender*

Date of Birth*

Place of Birth*

Student Identification*

Enter the ID Number*

Upload Passport Size Photo*

File size limit: 5 MB | File Format: JPEG or PNG

Contact Information

Address that we can use to send mail to. Usually, this is the address where you currently live.
Please locate Postal Code or Post Office using this indiapost.gov.in

Primary Number*

Alternate Number

Email*

Address Line 1*

Address Line 2*

City*

District*

State*

Country*

Pin Code*

Academic Information

Board of Exam*

Others

Medium of Instruction*

Mother Tongue*

School Name*

School City*

School State*

Results of Class X*

Class X marks

Upload Marksheet (if received)

The file should be in jpeg, png or pdf format

Family Information

Father’s Title*

Father’s First Name*

Father’s Last Name*

Father’s Phone Number*

Father’s Profession*

Father’s yearly income

Mother’s Title*

Mother’s First Name*

Mother’s Last Name*

Number of Brothers*

Number of Sisters*

I hereby declare that all the information given here is true. I take full responsibility of the details provided in the form. We will abide by all the rules and regulation of the institution.*

Yes

Admission form is closed right now.

Contact Alif Husna Academy for more details