SHRADHA SAMAJIK SEWA SANSTHAN

D2-117, Plot No-9, Gardenia Gateway Noida Sector-75 - 201301

Online Registration form for Session : 2025-2026

Candidate's Details

Name of the Student:

Seeking Admission to Class:

--Select-- NUR KG I II III IV V VI VII VIII IX X

DOB

Blood Group

--Select Blood Group-- O + O - A + A - B + B - AB + AB -

Nationality

--Select Nationality-- Indian Other than Indian

Religion

Caste

--Select Caste Category-- General OBC SC ST Other

Gender

--Select-- Male Female Other

Candidate's Aadhar No. if any

Handicap

--Select-- NA Blind Deaf Handicapped Dyslexic Spastic

Minority

--Select-- NO YES

Place of birth

Mother Tongue

Passport No

Passport - Date of issue

Passport - Date of expiry

Passport - Place of issue

Iqama No

Iqama - Date of issue

Iqama - Date of expiry

Iqama - Place of issue:

Iqama - Place of issue:

Name of School Last Studied

Class Last Studied

Date of leaving School

GR.NO./ SR.NO of any brother / sister presently studying in IISJ

Location

--Select-- Jeddah Makkah

Adhar No (if any)

Stream(Required in XI class only)

--Select-- Stream I - Humanities Stream II - Commerce Stream III -Science

Photograph(With Parents)

Parents' Details

Name of the Mother

Nationality

--Select Nationality-- Indian Other than Indian

Religion

CAST

--Select Cast Category-- General OBC SC ST Other

Occupation

Mobile No

Email Id

Mother Qualification

Place of Work

Working at iisjed

--Select-- No Yes

Emp Code

Passport No.

Passport - Date of issue

Passport - Date of expiry

Passport - Place of issue

Iqama No

Iqama - Date of issue

Iqama - Date of expiry

Iqama - Place of Issue

Name of the Father

Occupation

Nationality

--Select Nationality-- Indian Other than Indian

Date of Birth

CAST

--Select Cast Category-- General OBC SC ST Other

Religion

Passport No.

Passport - Date of issue

Passport - Date of expiry

Passport - Place of issue

Iqama No

Iqama - Date of issue

Iqama - Date of expiry

Iqama - Place of issue

Income group(IN SR)

--Select-- Below 3500 3500 - 7000 Above 7000

Annual Income

Residential Address

WhatsApp Number

Mobile Number

Email Id

Father Qualification

Place of Work

Working at iisjed

--Select-- No Yes

Emp Code

Office No

Sponsor's Contact No

Permanent Address(INDIA)

Name of the Guardian

Guardian's Address

City

State

--Select-- Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal Andaman and Nicobar Islands Chandigarh Dadra & Nagar Haveli Delhi Jammu and Kashmir Lakshadweep Puducherry Ladakh

Contact No(INDIA)

School Transport Needed

--Select-- No Yes

Remark if any

Whether the candidate is

Single Girl Child

Specially abled (Divyangjan)

Belonging to the EWS

Specially abled (Divyangjan)

Belonging to the EWS

Adhar No

Last School affiliated is

--Select--

Result of last class/Pre Board

Subject	Maximum Marks	Marks obtained	% of Marks
--Select--
--Select--
--Select--
--Select--
--Select--
--Select--
--Select--

Total

Year of passing

--Select-- 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Remark on Passing

Transfer Certificate No

Date of Issue Certificate

Course opt for class XI

PCM

PCB

COMM

HUMANITIES (ARTS)

Subject Opted

Compulsory Subject					Additional Subject Optional
Subject1	Subject2	Subject3	Subject4	Subject5	Subject6

Any brother or sister studying in the school

Name	1.	2.	3.
Class & Section	1.	2.	3.

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