LMOS Student Application

NAME*
(as per Birth Certificate)

SEX*

DATE OF BIRTH*

(dd/mm/yyyy)

PLACE OF BIRTH*

Nation*	State*	District*	City/Town*

LANGUAGE(S) SPOKEN AT HOME*

BLOOD GROUP*

ALLERGIC TO

Indians only ST / SC / BC / MBC / FC (details)
(To avail concessions from the Indian Government in future. Community Certificate should be submitted for SC, ST, BC, and MBC after the provisional admission)

Details of Siblings

Number of Sisters

Number of brothers

SKILLSET - Proficiency in any other field may be mentioned here

S No	Skill Description
1
2
3

PREVIOUS EDUCATIONAL BACKGROUND OF THE STUDENT (Not applicable for PRE KG):

Name of the school last attended (in full)*
School Address*
Building Number
Street Name
City*
District/County
State*
PIN/ZIP Code
Country*
School Phone*
Email
FAX
Educational Board* (Not required for LKG - I standard)	Any Other please specify
Affiliation / Registration / Approval No. of School Last attended (Not required for LKG - I standard)
School Academic year *	Starting month * Ending month *
Currently studying grade/class or Last studied grade/class)* (Promoted transfer certificate from the last school be submitted in original after the Provisional admission)
Current Medium of Education (Language)*
Currently studying Second Language (Not required for LKG - I Standard)
Currently studying Third Language (Not required for LKG - I Standard)

DETAILS OF ADMISSION SOUGHT (Academic year June 2007 to March 2008)*

Stream*	Level*	Grade/Class*	Second Language*	Third Language*

ACCOMMODATION/TRANSPORT REQUIREMENT*

Transport required *
Hostel (only for classes V to IX)**
**No boarding facilities for new admission to Class IX

BIO-DATA OF PARENTS*

Particulars	Father	Mother
Name as stated in the Passport/birth certificate of the child*
Educational Qualification
Occupation (Specify Designation)
Annual Income (in Rs/USD)
Office address	Bldg/Apartment Number: Street Name City: District/County: State: PIN/ZIP Code: Country: Work Phone (with STD and ISD code): Mobile Phone: Email: FAX:	Bldg/Apartment Number: Street Name: City: District/County: State: PIN/ZIP Code: Country: Work Phone(with STD and ISD code): Mobile Phone: Email: FAX:
		Same as Father's
Residential address	Bldg/Apartment Number: Street Name: City: District/County: State: PIN/ZIP Code: Country: Home Phone(with STD and ISD code): Mobile Phone: Email: FAX:	Bldg/Apartment Number: Street Name: City: District/County: State: PIN/ZIP Code: Country: Home Phone(with STD and ISD code): Mobile Phone: Email: FAX:

NAME OF LOCAL GUARDIAN/EMERGENCY CONTACT
(if none of the parent resides in Chennai)

Address	Bldg/Apartment Number: City: State: Country:	Street Name: District/County: PIN/ZIP Code:
	Home Phone (with STD and ISD code):	Work Phone (with STD and ISD code):
	Mobile Phone:
	Email:	FAX:

Address for further communication

Address:

Email:

Interaction/interview/written assessment will be on a weekend.
If called for interaction/interview/written assessment, when will your child be able to attend?

Application Form for Students(The details will be kept confidential and used for the LMOS school purpose only.)
Please fill in the form below with the details of your child and submit it for further processing. Fields marked * are mandatory
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