ASSAM STATE OPEN SCHOOL

ASSAM HIGHER SECONDARY EDUCATION COUNCIL

BAMUNIMAIDAM, GUWAHATI-21
Application form for admission 2023-B-BLOCK
A R N No. For Office Use of ASC only

Enrolment No.
(Please verify the enrolment no. correctly)
Date .......................... Signature .............................
IMPORTANT INSTRUCTIONS
1. Please fill up the form with black ball pen only after reading the instructions.
2. After filling up the form, make two photocopies of the form without signing it. Paste your recent passport size
3. Paste your photograph on the original form and both the photocopies. coloured photograph here

4. Sign all the forms and submit the copies to the Study Centre.
Sign in the box below
Name of the ASC

1. Name of the Learner in Full CAPITAL LETTERS [As per H.S.L.C. Record] : [Keep space between Name and Title]

2. Father’s name in Full CAPITAL LETTERS [As per H.S.L.C. Record] : [Keep space between Name and Title]

3. Mother’s name in Full CAPITAL LETTERS [As per H.S.L.C. Record] : [Keep space between Name and Title]

4. Gender M F 5. Category GEN OBC MOBC ST SC OTHERS

(Please Tick Mark) (Please Tick Mark)
6. Date of birth 7. Postal Address (in BLOCK letters)
[As per H.S.L.C. Record] D D M M Y Y Y Y
8. Religion Vill / Town : ______________________________________
9. Nationality _________________________________________________
P.O. : ______________________________________
10. Other Country, if not INDIA
District : ______________________________________
11. Whether Physically Challenged YES NO Pin Code : ______________________________________
(Please Tick Mark) Mobile No : ______________________________________
(i) Write the category in the box
12. Whether employed (Please Tick Mark) YES NO 13. Aadhaar No. (If available)
14. Educational Qualification (Minimum H.S.L.C./Class Xth Board Examination Passed)
Name of Examination Board/Council Year of Passing Roll No Result 17. Are you applying for TOC ?
(Please Tick Mark)
YES NO
15. Educational Qualification (H.S./Class XII Examination Passed) Yes / No Name of the Board
Name of Examination Board/Council Year of Passing Roll No Result last appeared
Year of appearing
in last exam.
16. Choose Subjects [See Table 1 of the prospectus & put the subject codes] Roll
Medium of study ENG ASS B. Group B {Minimum 3 and C. Only one subject from No
A. Group A {Minimum 1 and Maximum 4} each Group of C. D. E. F. 18. Details of subject applied for TOC
Maximum 2} Code No. Name of the subject Code No. Name of the subject
(Subjects having below 33% of marks will not
Code No. Name of the subject From Group C be entitled)

From Group D Subjects Subject code Marks obtained Total

of ASOS Theory Practical
From Group E
(Total subjects: Minimum 5 and
From Group F
Maximum 7) (Including Additional &
TOC is admissible to the learner who has appeared this H.S. Final
TOC Subjects) [SUBJECTS ARE TO BE OFFERED AS PER REQUIREMENT OF FURTHER STUDIES] Examination within 5(five) years from the date of admission [(i.e.2019
or later, for the session 2023(B-Block)]
19. Total amount of fee paid

Amount
Course TOC Additional Prospectus Other Board
Admission Registration verification fee
Total
material fee subject fee subject fee fee

20. DECLARATION BY APPLICANT

I do hereby declare that I have read and understood the condition of eligibility and fulfil the criteria for which I seek
admission. All the necessary documents and information furnished by me is correct. I have filled this form in my own handwriting
and understood that my candidature is liable to be cancelled by ASOS in the event of any information or document is being found
misleading or incorrect, at any stage. I accept the rules as laid down in this Prospectus.

Date ..................................... ....................................................................

(Signature of Learner)
(Full Name)
.........................................................................
(Counter Signature of the Parents/Guardian)

Certificate From the Principal cum Co-ordinator

All the documents mentioned below have been verified with the original documents issued by the concerning Board/Council.

PLEASE CHECK THE ENCLOSURES AND TICK

Original Admission form & two photocopies Certificate of Date of birth as per H.S.L.C. Admit Card
of the original form along with the enclosure)
Attested photocopy of admit card, mark- Attested photocopy of Caste certificate (if applicable)
sheet & pass certificate of H.S.L.C./Class Xth
passed examination.
Attested photocopy of mark-sheet of H.S. Attested photocopy of Medical certificate (in case of
Final examination for Part Admission/ TOC Physically Challenged learner)

Certified that the admission form along with the requisite fee and documents are checked and found correct. The admission is
provisionally registered allotting enrolment ……

___________________________________________________
Place: Seal Signature of the Principal cum Co-ordinator

Date: Name: ..........................................................................................

Address: .......................................................................................
Note : The Application Form will be summarily rejected if ….
1. Father’s / Mother’s name is not mentioned or not matched with H.S.L.C. record.
2. Date of birth / Year of Passing class 10 is not mentioned or not matched with H.S.L.C. record.
3. Requisite number of subjects not offered.
4. Requisite Fee is not paid.
5. Uploaded/ submitted Documents are blurred.
6. Class 10 qualifying board is mentioned as SEBA but uploaded documents are issued from board other than SEBA.
7. Uploaded wrong / irrelevant Document(s).
8. Name registered is mismatched with uploaded documents.