Liverpool Secondary School/College

New Baneshwor, Kathmandu
+977-1-4791230, 4794560 | info@liverpool.edu.np

APPLICATION FORM

FOR GRADE XI

New Baneshwor, Kathmandu
Tel: +977-1-4791230, 4794560
URL: www.liverpool.edu.np
E-mail: info@liverpool.edu.np

Fields with (*) are compulsory.

Faculty Applied For

Science

Management

Law

Shift *:

Day

Morning

Personal Information

Name of Applicant (Full Name)*: REG. NO.:

Date of Birth*:

B.S.

A.D.

Gender*: Male Female Other

Age:

Nationality*:

Phone (Res.):

Mobile No.*:

Academic Information

Name of SEE Appeared School*:

District:

Board*:

SEE Appeared Year*:

GPA*:

S.N.	Subject	Sub. Grade
1.
2.
3.
4.

Fields Interested/ Participated (Max 250 characters)

Parent's Information

FATHER'S INFORMATION

Father's Name:

Email:

Residential Status:

Mobile No.:

Designation:

Office:

Telephone(Office):

MOTHER'S INFORMATION

Mother's Name:

Email:

Residential Status:

Mobile No:

Designation:

Office:

Telephone(Office):

GUARDIAN'S INFORMATION

Local Guardian's Name :

Address:

Relationship:

Occupation:

Mobile No.:

Telephone(Home):

CONTACT ADDRESS

PERMANENT ADDRESS

Country :

Province :

District :

Municipality :

Ward No :

Area :

House No:

CURRENT CONTACT ADDRESS

Same as Permanent Address

Country :

Province:

District :

Municipality :

Ward No :

Area :

House No:

Other Information

Do you require transportation?*

Yes No

If Yes, please mention the nearest BUS STOP and landmark:

If ‘No’, Please mention how you will come to school:

Do you require hostel facilities?*

Yes No

From where did you acquire information about the college?*

Friends, parents, relatives, etc.

Former School

Teachers

Newspaper Advertisements

Exhibition or Seminar

TV / Radio Advertisements

Internet/ Social Media

Others

ADDITIONAL INFORMATION (Max 250 characters)

Declaration

Students are required to be in the College premises everyday at least five minutes before the commencement of classes.
Dress-code must be maintained properly. Each and every student must be in clean and pressed College Uniform (as prescribed by the College) along with simple black leather-shoes with lace.
No one is allowed to go outside the College premises at break/recess.
Seating on tables, stairs, desks, library tables and hanging around along the corridor are regarded as irritating habits.
In case of emergency, students are advised to inform concerned authorities in advance through written application.
Students nominated for extra/tutorial classes must take maximum advantage by attending those classes regularly.
No student is permitted to miss Unit Tests/Internal Assessments, Terminal Examinations and Pre-Board Examinations. The College Management will not provide a green signal to appear at the Final Board without maintaining necessary pass marks in all related subjects in the Pre-Board Examination.
Wearing of ear-rings, top/bangles, polo-neck/round-neck sweater, etc. are completely prohibited. Students must put on prescribed coat during winter.
Students are strictly prohibited from bringing magazines, picture post cards, comic books, video games, I-pods, radio, weapons and any sort of liquor to the College.
Students are allowed to bring the Cell Phone but it must be deposited in the information center before they enter into their classrooms.
Smoking cigarette/marijuana, using drugs/tobacco products, chewing gum inside or outside the College premises, etc. are forbidden. The students who get into one-to-one fight/gang fight inside or outside the College premises are regarded as violators of College norms. Such students are subject to direct expulsion.
The students themselves being the firm linkage between the College Management and their parents/guardians, it is their moral responsibility to pass on immediately all important notified information to their parents/guardians.
The students have to incur all expenses if he/she causes damage (writing on the wall/ breaking/disfiguring/tearing or loosing of library books, etc.) to the College property.
The parents/guardians should be present on every result day to discuss the progress of the students.

I/We have read, understood and agreed upon the aforementioned rules and regulations of the College and would like to hereby admit that teaching-learning involves a 3 - faced approach - the student, the teacher and the parent/guardian. I/We, with our full consent, declare that the College has the full authority to amend and implement rules and regulations with or without prior notice for the academic enhancement. I, as a parent/ guardian, further agree to come to college when required.

Signature of parent/guardian

Signature of student

I/We hereby certify that the information provided in this application is complete and correct. I/We agree that Liverpool SS/College may, if necessary, verify details of the educational qualifications.

Student’s Signature

Parent’s / Guardian’s Signature

Date

Documents

Document Name	File

Please attach the specified documents along with the form.

SEE Marksheet
SEE Character
Original migration certificate (if applicable)