Appln For Enrolment

NATIONAL SERVICE SCHEME APPLICATION FOR ENROLMENT Name Of School: …………………………………………………………………………….. 1. Name of student ( In block letters ) 2. Class

: ………………………………………………………

3. Date of birth

: ………………………………………………………

4. Sex

: Male (

5. Caste

: SC (

6. Name of guardian

: ………………………………………………………

7. Residential address

: ………………………………………………………

: ………………………………………………………

) )

Female ( ST (

)

) OBC (

)

GEN (

)

……………………………………………………… 8. Telephone number

: ………………………………………………………

9. Blood group

: ………………………………………………………

10. Talents (specify )

: ………………………………………………………

11. Area of interest ( specify ) : ……………………………………………………… (environment/Health/ Rural/ Education/reconstruction ete.) ……………………………………………………… DECLARATION I ………………………………………………….. hereby agree to obey all the rules and regulations of National Service Scheme and work imbibing the spirit of the scheme. Place : Date :

Signature of applicant FOR OFFICE USE ONLY

Date of enrolment

:

Enrolment No.

:

Remarks if any

: Signature of the Programme Officer.