CHENNAI PUBLIC SCHOOL (ANNA NAGAR)
APPLICATION FORM NO.: ANA-2425-1179
Name of the Student M VIJAY KRISHNA Gender Male
Class applied for CBSE - XI
Group B - Computer Science, Mathematics, Physics, Chemistry
Date of Birth 31-03-2009 Blood Group B Positive
Nationality Indian
Religion Hindu
Community MBC Sub Caste Isaivellalar
Mother Tongue Tamil
Student Aadhaar No. 550244741966
Address FLAT NO S1,D BLOCK,BRS PARADISE, SARANGAPANI NAGAR
MADHAVARAM,CHENNAI 600060, - 600060
, INDIA
Preferred Mobile No. 9445666581
Email ID BMKUMARCHENNAI123@GMAIL.COM
PARENT DETAILS
Name B MUTHUKUMAR PK RANJINI
Relationship Father Mother
Qualification B TECH BSC MATHS
Occupation Public Sector Others (House Wife)
Organization Name North Chennai Thermal Power Station/Tangedco
Designation Assistant Executive Engineer
Office Address O/O Executive Engineer,Ash-Handling Plant, Nctps,Chennai-
600120
Annual Income 20-30 lakhs -
Mobile No. 9445666581 9497255234
Email ID BMKUMARCHENNAI123@GMAIL.COM jayanthkrish02@gmail.com
GUARDIAN DETAILS
Name B VIJAYA
Relationship with the Applicant Grandmother
Qualification SSLC
Occupation Others ()
Office Address
Mobile No. 9962496204
Email ID
SCHOLASTICS (ACADEMICS)
Academic Year 2023-2024 2022-2023
GREENFIELD CHENNAI INTERNATIONAL GREENFIELD CHENNAI INTERNATIONAL
Name of the School & Address SCHOOL,1A,200 FEET RING RD, SCHOOL,1A,200 FEET RING RD,
MADHAVARAM,CHENNAI-600110 MADHAVARAM,CHENNAI-600110
Class X IX
Board CBSE CBSE
Medium of instruction English English
II/III Language studied Tamil Tamil
Overall Grade/Percentage 92.4 85.83
Learning disabilities, if any No
Break of study, if any No
CO-SCHOLASTICS (ART / MUSIC / DANCE / THEATRE / DEBATE ETC.,)
Co-Scholastics
Sports / Games
Talent Exam / Olympiads
Certification
Community Service
PREFERENCES & OTHERS
Medical ailments/allergies No
Sibling applying to CPS No
Sibling studying in CPS Student Name School Class
PARENT'S WILLINGNESS TO VOLUNTEER IN SCHOOL ACTIVITY
Teaching
HOW DID YOU COME TO KNOW ABOUT CPS
Word Of Mouth
DECLARATION BY PARENT
I hereby declare that the above mentioned details are true to the best of my knowledge.
I understand that admission is subject to fulfilling the admission criteria and availability of seats. I also understand that the management reserves
the right to offer / decline admission to my ward without assigning any reason. I am also aware that school is not collecting any donation and
influencing by way of monetary consideration or any other unethical means to secure admission will lead to summary rejection of my ward's
admission. I agree to the decision of the admission committee which will be final and binding. School is not held responsible, if I do not receive any
communication due to incorrect E-mail IDs / contact numbers / mobile numbers registered in DND format / address and may not be limited to the
above reasons.
I also understand that the Online Application Form is non-transferable and the application fee / admission fee is non-refundable; Incomplete
Application Form will not be processed. I further understand that annual fee has to be paid at the beginning of every academic year.
I agree to abide by the school norms and co-operate as required in all areas.
DATE : 17-05-2024 B MUTHUKUMAR
PLACE : SIGNATURE OF PARENT
ADMISSION RECOMMENDATIONS
DATE : PRINCIPAL
