The document is an admission form for a student named Om Prashant Sawant applying for Class 3. It includes details about the student and parents such as name, date of birth, address, contact details, previous school, health details, and consent for emergency medication. The form also includes documents required for admission and a parental engagement form outlining expectations for parents.

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For Office Use
GR.No.
Reg No. 201920130320117
Parent Id
ESIS No.
Admission Form
STUDENT ADMISSION DETAILS
Login Id 201920130320117 Admission Form No. 201920/2512
Class 3
STUDENT DETAILS
First name OM Middle name PRASHANT
Last name SAWANT Gender Male
Date of birth 13-03-2011 Place of birth MUMBAI
Nationality INDIAN Religion HINDUISM
Mother Tongue MARATHI CPR No. 784201184218580
CPR No. Valid upto Date 11-08-2020
Passport No. N8359837 Passport Expiry Date 03-04-2021
Visa 32084636 Visa Expiry Date 12-08-2020
CONTACT DETAILS
Address VILLA 57, SECTOR 14, MBZ CITY
Annual Income 189000
PO Box no./Block 111902
Home phone no -
PARENT DETAILS
Father Name PRASHANT SAWANT Mothers Name SUNAYANA SAWANT
Father Email Id praver11@yahoo.com Mother Email Id praver11@gmail.com
Father Mobile No +971508118399 Mother Mobile No +971562227690
Father CPR No. 784198031715406 Mother CPR No. 784198308262579
Father CPR No. Valid upto Date 11-02-2021 Mother CPR No. Valid upto Date 11-08-2020
Father Visa 78419803175406 Mother Visa 28047624
Father Visa Valid upto Date 11-02-2021 Mother Visa Valid upto Date 11-08-2020
Father Nationality INDIAN Mother Nationality INDIAN
Father Passport No. K4073697 Mother Passport No. J6098618
Father Passport Expiry Date 23-05-2022 Mother Passport Expiry Date 04-03-2021
Father Employer Name SYNAXIS SAVETO L.L.C. Mother Employer Name -
Father Current Position PRODUCTION ENGINEER Mother Current Position -
Father Address VILLA 57, SECTOR 14, MBZ CITY Mother Address VILLA 57, SECTOR 14, MBZ CITY
PREVIOUS SCHOOLS DETAILS
Previous School Name GIIS ABU DHABI Medical Condition -
Curriculum Followed - Language Of Instruction -
Second language -
Academic Year 2019-2020
HEALTH DETAILS
Blood Group O+VE
DETAILS OF SIBLING STUDYING IN THIS SCHOOL
I____________________________________________________ declare that the information provided above is true and accurate and to
the best of my knowledge. I have read the guidelines and instructions to the parents and undertake to abide by the rules of this institution
in force from time to time and decision of Head of the School in all matters.
Admission are Subject to ADEC approval.
Date__________________Name of the Parent_____________________________Signature_______________

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For Office Use Only
Admit_____________________________________________son/Daughter of____________________________________
To Class__________________Section____________Stream____________subject to the payment of full school dues
Admission Incharge_______________________ Principal_______________________
Payment Details
Admission Fee(AED)______________Receipt No.__________Date_________
Tuition Fee________________________ Science Pract Fee._______________
Exam Fee____________________Magazine Fee_______________________
Books Fee_________________Games & Sports Fee____________________
Caution Money___________________Bus Fee_________________________
Total______________________Receipt NO_________________Date_______
Accountant
Document Check List
ELECTRICITY BILL OR TENANCY CONTRACT
EMIRATES ID COPY OF SPONSORS
PASSPORT COPY OF SPONSOR WITH VISA PAGE
INSURANCE AND VACCINATION CARD COPY
ATTESTED PROMOTED TC
LATEST MARK SHEET / PROGRESS REPORT.
PASSPORT COPY OF CHILD WITH VISA PAGE
PARENT COLOR PHOTOGRAPH
EMIRATES ID COPY OF CHILD (2 NOS)
STUDENTS COLOR PHOTOGRAPH
STUDENTS ATTESTED BIRTH CERTIFICATE COPY

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ABU DHABI INDIAN SCHOOL, BRANCH I, AL WATHBA
PARENTAL ENGAGEMENT FORM
I, _____________________________, do hereby promise to meet the following expectations with regards to my parental
responsibilities.
I promise to treat my child with respect and compassion. I will not belittle, degrade, or insult my child regardless of
his or her actions. I will treat my child the way I would have wanted to be treated when I was his or her age.
I promise to spend a reasonable amount of quality time with my child each day and to give him or her positive
attention when appropriate.
I promise to set a good example for my child by being the best role-model that I can be. I will demonstrate appropriate
ways to handle difficult emotions and will behave in a socially responsible manner. I will teach my child to be caring,
patient, reliable, and respectful by being that way myself.
I will work my hardest to teach my child how he or she SHOULD be acting instead of focusing so much on how he or
she SHOULD NOT be acting.
I will use everyday situations as teaching opportunities for my child. Sometimes it is better for my child to learn from
the mistakes of others than from his or her own mistakes.
I promise to avoid "giving-in" to my child's crying, tantrums, or threats. Doing so will only increase the likelihood of
these behaviours in the future.
Most of all, I promise to keep my child safe from physical and/or emotional harm. I will provide a safe, secure, and
nurturing environment for my child–one that allows him or her to thrive. I will provide adequate food, drink, medical
care, and clothing for my child and will make sure that he or she sleeps in a warm and safe bed each night.
I will cooperate and support my child in all the learning activities (homework’s, assignments, and projects) and we
understand that the journey of my child towards education can be accomplished only the support rendered by both
the parents and the school.
If I am able to meet the conditions stated in this form, then I can feel proud of my parenting accomplishments. I do realize
though, that these conditions alone will not make me a quality parent. I will need to work diligently each day to become
the quality parent that I strive to be.
Signature of the Parent(s) __________________________
Counsellor Principal

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ABU DHABI INDIAN SCHOOL, BRANCH 1 – AL WATHBA
STUDENT MEDICAL INFORMATION FORM
FULL NAME OF STUDENT : _________________________________________________
CLASS: ______________ SECTION: ________________ G.R.NO.:______________
DATE OF BIRTH: ______________________ BLOOD GROUP: ___________________
GENDER : _________________________________________________________________
PHOTO OF STUDENT
FATHER’S FULL NAME : __________________________________________________________________
FATHER’S MOBILE NO.: __________________________________________________________________
FATHER’S EMAIL ID : __________________________________________________________________
MOTHER’S FULL NAME: _________________________________________________________________
MOTHER’S MOBILE NO.: _________________________________________________________________
MOTHER’S EMAIL ID : _________________________________________________________________
RESIDENCE NO. : ________________________________________________________________________
OTHER CONTACT PERSON FOR EMERGENCY:
NAME OF CONTACT PERSON : ____________________________________________________________
RELATION: ______________________________________________________________________________
MOBILE NO.: ____________________________________________________________________________
NAME OF CONSULTING CLINIC: ___________________________________________________________
NAME OF CONSULTING DOCTOR: _________________________________________________________
CONTACT NO. OF CLINIC/DOCTOR: ________________________________________________________

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DOES YOUR CHILD HAVE ANY OF THE FOLLOWING?
IF YES, PLEASE INCLUDE DETAILS SUCH AS SPECIFIC DIAGNOSIS, SEVERITY, CURRENT
TREATMENT AND MEDICATION
CONDITION YES/NO DETAILS
ASTHAMA
DIABETES
ECZEMA
ALLERGY (SPECIFY)
HEARING DIFFICULTIES
VISUAL AIDS
SEIZURE
DISORDER/EPILEPSY
ANY SURGERY
HAS YOUR CHILD HAD
ANY OF THE FOLLOWING?
MEASLES
MUMPS
RUBELLA
CHICKEN POX
POLIO
HEPATITUS
G6 PD
THALASAEMIA
BLEEDING DISORDER
PLEASE STATE ANY OTHER MEDICAL INFORMATION OR CONCERNS YOU MAY HAVE
REGARDING YOUR WARD TO ENHANCE THEIR SCHOOL SAFETY: _______________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
PARENT SIGNATURE: ___________________________________

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ABU DHABI INDIAN SCHOOL, BRANCH 1 – AL WATHBA
PARENTAL CONSENT TO ADMINISTER EMERGENCY MEDICATION
‫طﻔﻠﻲ‬ ‫ان‬ ‫ﻋﻠﻰ‬ ‫/اواﻓق‬I consent that my child:
‫/اﻻﺳم‬Name :___________________________________________ ‫اﻟﻣﯾﻼد‬ ‫/ﺗﺎرﯾﺦ‬Date of Birth:_________________
‫اﻟﻌﻧوان‬ /Address: _____________________________________________________________________________
‫اﻟﮭﺎﺗف‬ ‫/رﻗم‬Phone No: _________________ ‫اﻟﻔﺋﺔ‬ /Class: __________________ ‫اﻟﺷﻌﺑﺔ‬ /Division: _________________
‫اﻟﺗﺎﻟﯾﺔ‬ ‫اﻟﺣﺎﻻت‬ ‫ﻓﻰ‬ ‫اﻟﻣﻧﺎﺳب‬ ‫اﻟدواء‬ ‫إﻋطﺎء‬
Be Given the appropriate medication in the following cases
/1 ‫ﻋﺼﺒﯿﺔ‬ ‫ﺻﺪﻣﺔ‬ ) ‫ﺣﺎد‬ ‫اﻟﺘﺤﺴﺴﻲ‬ ‫ﻓﻌﻞ‬ ‫رد‬ ‫ﻓﻰ‬ ‫ﻻدرﯾﻨﺎﻟﯿﻦ‬ ‫اﻹدارة‬
Administration of Epinephrine in an acute allergic reaction (anaphylactic shock)
/2 ‫اﻟﺮﺑﻮ‬ ‫اﻋﺮاض‬ ‫ﻓﻰ‬ ‫ﻟﻠﺘﺤﻜﻢ‬ ‫اﻟﺴﺎﻟﺒﻮﺗﺎﻣﻮل‬ ‫اﺳﺘﻨﺸﺎق‬ ‫إدارة‬
Administration of Salbutamol Inhaler to control asthmatic symptoms
/3 ‫اﻟﺪم‬ ‫ﻓﻰ‬ ‫اﻟﺴﻜﺮ‬ ‫ﻟﻨﻘﺺ‬ ‫اﻟﻔﻢ‬ ‫طﺮﯾﻖ‬ ‫ﻋﻦ‬ ‫اﻟﺠﻠﻜﻮز‬ ‫او‬ ‫إدارة‬
Administration or Oral Glucose for hypoglycemia
/4 ‫واﻟﺤﻤﻲ‬ ‫اﻷﻟﻢ‬ ‫ﻣﻦ‬ ‫ﻣﻌﺘﺪﻟﺔ‬ ‫إﻟﻰ‬ ‫ﺧﻔﯿﻔﺔ‬ ‫ﻓﻰ‬ ‫ﻟﻠﺘﺤﻜﻢ‬ ‫ﺑﺎراﺳﯿﺘﯿﻤﻮل‬ ‫إدارة‬
Administration of Paracetemol to control mild to moderate pain and fever
/5 ‫ﻟﻠﺤﺴﺎﺳﯿﺔ‬ " ‫ﻣﻀﺎدات‬ ‫)ﻣﻮﺿﻌﻲ("ﻛﺮﯾﻢ‬ ‫إدارة‬
Administration (topical) of Antihistamine Cream for allergic reaction
‫؟‬ ‫ﻣﻌرﻓﺗﮭﺎ‬ ‫اﻟﻰ‬ ‫اﻟﻰ‬ ‫ﺑﺣﺎﺟﺔ‬ ‫اﻟﻣدرﺳﺔ‬ ‫ﻓﻰ‬ ‫اﻟﻌﺎﻣﻠﯾن‬ ‫ان‬ ‫ﻣواﻧﻊ‬ ‫اى‬ ‫؟‬ ‫ﻟﻣﻌرﻓﺗﮭﺎ‬ ‫ﺑﺣﺎﺟﺔ‬ ‫اﻟﻣدرﺳﺔ‬ ‫ﻣوظﻔﻲ‬ ‫اﺣﺗﯾﺎطﺎت‬ ‫اى‬
Any precautions that school personnel Any contraindications that school personnel need to Know
‫؟‬ ‫اﻟﺟﺎﻧﺑﯾﺔ‬ ‫اﻵﺛﺎر‬ / ‫اﻟﻣﺣﺗﻣﻠﺔ‬ ‫اﻟﻔﻌل‬ ‫ردود‬ ‫ﻣﺎھﻰ‬ ‫؟‬ ‫ﺟﺎﻧﺑﻰ‬ ‫ﺗﺎﺛﯾر‬ ‫أو‬ ‫ﻓﻌل‬ ‫ردة‬ ‫ﺣدوث‬ ‫ﺣﺎﻟﺔ‬ ‫ﻓﻰ‬ ‫ﻓﻌﻠﺔ‬ ‫ﻣﺎﯾﻧﺑﻐﻰ‬
What are the possible reactions / side effects ? What should be done in the event of reaction or side effect?
Check the box below:
o ‫اﻟﺼﻠﺔ‬ ‫ذات‬ ‫اﻟﺴﯿﺎﺳﺎت‬ ‫و‬ ‫اﻟﻤﻌﺎﯾﯿﺮ‬ ‫ﻟﮭﺬه‬ ‫وﻓﻘﺎ‬ ‫طﺒﯿﺐ‬ / ‫ﻣﻤﺮﺿﺔ‬ ‫ﻣﺪرﺳﺔ‬ ‫اﻟﻤﺮﺧﺼﺔ‬ ‫اﻟﺼﺤﺔ‬ ‫ھﯿﺌﺔ‬ ‫ﻗﺒﻞ‬ ‫ﻣﻦ‬ ‫ﺗﺪار‬ ‫أن‬ ‫ﯾﻤﻜﻦ‬ ‫أﻋﻼه‬ ‫اﻟﺪواءاﻟﻤﺬﻛﻮر‬ - ‫.ﻧﻌﻢ‬
YES – The above medication can be administered by a HAAD Licensed School Nurse/Physician in accordance with
this standard and the relevant policies.
o ‫اﻟﻄﺒﯿﺐ‬ / ‫اﻟﻤﺪرﺳﺔ‬ ‫ﻣﻤﺮﺿﺔ‬ ‫اﻟﻤﺮﺧﺼﺔ‬ ‫اﻟﺼﺤﺔ‬ ‫ھﯿﺌﺔ‬ ‫ﻗﺒﻞ‬ ‫ﻣﻦ‬ ‫ﺗﺪار‬ ‫أن‬ ‫ﯾﻤﻜﻦ‬ ‫ﻻ‬ ‫أﻋﻼه‬ ‫اﻟﻤﺬﻛﻮر‬ ‫اﻟﺪواء‬ .
NO – The above medication cannot be administered by a HAAD Licensed School Nurse/Physician.
/ ‫اﻟوﺻﻲ‬ ‫او‬ ‫ﻟﻠواﻟد‬ ‫ﺑﺎﻟﻛﺎﻣل‬ ‫اﻻﺳم‬Parent/Guardian-Full name: ……………………………………………
/ ‫اﻟوﺻﻲ‬ ‫او‬ ‫اﻟزاﻟد‬ ‫ﺗوﻗﯾﻊ‬Parent/Guardian signature: …………………………………………….
‫اﻟﺗﺎرﯾﺦ‬Date ……………………………….

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ABU DHABI INDIAN SCHOOL, BRANCH 1 – AL WATHBA
GENERAL CONSENT FORM
I understand and I agree on providing medical services for my
son/daughter:
Student Name: ………………………………………………………
School Name: ……………………………………………………….
Grade:……………………………………Section:………………….
G.R.No:………………………………
In the school clinic by school health team.
I also agree that these medical services will remain provided to my
son/daughter and effective until I either refuse providing these
medical services or he/she is transferred from Abu Dhabi Indian
School, Branch 1.
My consent involves a general approval of curative or/and
preventive services that may include first aid,screening for height,
weight, vision acuity, vaccination and referral to primarily health
centers or emergency room when necessary.
I understand that some of the diagnostic results may be reported to
the concerned official departments (such as HAAD, ADEC or any
another official entity)
In case of refusal please, be informed that no services will be
offered unless it’s an emergency then we should intervene.
If my son/daughter needed to be transferred to the emergency unit
in my absence and the absence of the legal guardian, then I
authorize the school administration to transfer him/her to
emergency unit.
Agree o
Disagree o
In case disagree, please specify reason:
_________________________________________________
_________________________________________________
Signature of student’s parent (please don’t use pencil)
Name:________________________________________
Relation to the student:__________________________
Tel #: _________________________________________
Date: _________________________________________
Signature:_____________________________________
If the parent can’t consent for son/ daughter for any reason, the
signature of the legal guardian must be obtained.
Signature of legal guardian (please don’t use pencil)
Name:________________________________________
Relation to the student:__________________________
Tel #: _________________________________________
Date: _________________________________________
Signature:_____________________________________
‫إﺑﻧﺗﻰ‬ / ‫ﻹﺑﻧﻰ‬ ‫اﻟﺻﺣﯾﺔ‬ ‫اﻟﺧدﻣﺎت‬ ‫ﺗﻘدﯾم‬ ‫ﻋﻠﻰ‬ ‫أواﻓق‬ ‫ﺗدﻧﺎه‬ ‫اﻟﻣوﻗﻊ‬ ‫اﻧﺎ‬
................................................: ‫اﻟطﺎﻟﺑﺔ‬ / ‫اﻟطﺎﻟب‬
....................................................... : ‫اﻟﻣدرﺳﺔ‬
......................... : ‫اﻟﺷﻌﺑﺔ‬ .......................: ‫اﻟﺻف‬
................................................. : ‫اﻟﻣدرﺳﻲ‬ ‫اﻟرﻗم‬
. ‫اﻟﻣدرﺳﯾﺔ‬ ‫اﻟﺻﺣﺔ‬ ‫ﻓرﯾق‬ ‫ﺑواﺳطﺔ‬ ‫اﻟﻣدرﺳﺔ‬ ‫ﻋﯾﺎدة‬ ‫ﻓﻰ‬
‫اﻟﺧدﻣﺎت‬ ‫ھذه‬ ‫ﺗﻘدﯾم‬ ‫ﺑرﻓض‬ ‫اﻧﺎ‬ ‫اﻗوم‬ ‫ﻟﺣﯾن‬ ‫اﻟﻣﻔﻌول‬ ‫ﺳﺎرى‬ ‫ﯾﺑﻘﻰ‬ ‫اﻟﺻﺣﯾﺔ‬ ‫اﻟﺧدﻣﺎت‬ ‫ھذه‬ ‫ﻋﻠﻰ‬ ‫ﻣن‬ ‫ﻣواﻓﻘﺗﻰ‬ ‫إن‬
. 1- ‫ﻓرع‬ ‫اﻟﮭﻧدﯾﺔ‬ ‫أﺑوظﺑﻲ‬ ‫ﻣدرﺳﺔ‬ ‫ﻣن‬ ‫/اﻟطﺎﻟﺑﺔ‬ ‫اﻟطﺎﻟب‬ ‫إﻧﺗﻘﺎل‬ ‫ﻟﺣﯾن‬ ‫او‬ ‫إﺑﻧﺗﻰ‬ / ‫ﻹﺑﻧﻲ‬
‫وﺗﺷﻣل‬ ‫ﻋﻼﺟﯾﺔ‬ ‫وﻗﺎﺋﯾﺔ‬ ‫اﺟراءات‬ ‫اى‬ ‫ﻋﻠﻰ‬ ‫ﻋﺎﻣﺔ‬ ‫ﻣواﻓﻘﺔ‬ ‫ھﻰ‬ ‫اﻟﺻﺣﯾﺔ‬ ‫اﻟﺧدﻣﺎت‬ ‫ھذه‬ ‫ﻋﻠﻰ‬ ‫ﻣواﻓﻘﺗﻰ‬ ‫إن‬
‫واﻟﺗطﻌﯾﻣﺎت‬ ‫اﻟﻧظر‬ ‫وﺣدة‬ ، ‫واﻟطول‬ ‫اﻟوزن‬ ‫ﻗﯾﺎس‬ ، ‫اﻷوﻟﯾﺔ‬ ‫اﻹﺳﻌﺎﻓﺎت‬
. ‫اﻟﺿرورة‬ ‫ﻋﻧد‬ ‫اﻟطوارى‬ ‫وﻗﺳم‬ ‫اﻷوﻟﯾﺔ‬ ‫اﻟﺻﺣﯾﺔ‬ ‫اﻟرﻋﺎﯾﺔ‬ ‫ﻣرﻛز‬ ‫إﻟﻰ‬ ‫واﻟﺗﺣوﯾﻼت‬
‫أﺑوظﺑﻲ‬ ‫اﻟﺻﺣﺔ‬ ‫ھﯾﺋﺔ‬ ) ‫ﻣﺛل‬ ‫واﻟﻣﻌﻧﯾﺔ‬ ‫اﻟرﺳﻣﯾﺔ‬ ‫اﻟﺟﮭﺎت‬ ‫اﻟﻰ‬ ‫ﺗﺑﻠﯾﻐﮭﺎ‬ ‫ﯾﺗم‬ ‫ﻗد‬ ‫اﻟﻔﺣوﺻﺎت‬ ‫ھذة‬ ‫ﺑﻌض‬ ‫ﻧﺗﯾﺟﺔ‬ ‫إن‬
. ‫ﺧرى‬ُ‫أ‬ ‫رﺳﻣﯾﺔ‬ ‫ﺟﮭﺔ‬ ‫اى‬ ‫او‬ ( ‫ﻟﻠﺗﻌﻠﯾم‬ ‫أﺑوظﺑﻲ‬ ‫ﻣﺟﻠس‬ –
‫ﻓﻰ‬ ‫ﻟﮭﺎ‬ ‫إﺑﻧﺗﻛم‬ / ‫إﺑﻧﻛم‬ ‫ﺣﺎﺟﺔ‬ ‫ﻋﻧد‬ ‫اﻟﺧدﻣﺎت‬ ‫ھذه‬ ‫ﺗﻘدﯾم‬ ‫ﻧﺳﺗطﯾﻊ‬ ‫ﻟن‬ ‫ﺑﺄﻧﮫ‬ ‫اﻟﻌﻠم‬ ‫ﯾرﺟﻰ‬ ‫ﻣواﻓﻘﺗﻛم‬ ‫ﻋدم‬ ‫ﺣﺎﻟﺔ‬ ‫ﻓﻰ‬
. ‫اﻟﺳرﯾﻊ‬ ‫ﺗدﺧﻠﻧﺎ‬ ‫ﺗﻠزم‬ ‫اﻟﺗﻰ‬ ‫اﻟﻘﺻوى‬ ‫اﻟطﺎرﺋﺔ‬ ‫اﻟﺣﺎﻻت‬
‫ﯾﻧوب‬ ‫ﻣن‬ ‫أو‬ ‫اﻧﺎ‬ ً‫ا‬‫ﻣوﺟود‬ ‫اﻛن‬ ‫وﻟم‬ ‫اﻟطوارى‬ ‫إﻟﻰ‬ ‫اﻟﻧﻘل‬ ‫ﺗﺳﺗدﻋﻰ‬ ‫طﺎرﺋﺔ‬ ‫ﺣﺎﻟﺔ‬ ‫ﺑﺄى‬ ‫/إﺑﻧﺗﻰ‬ ‫إﺑﻧﻰ‬ ‫اﺻﯾب‬ ‫إذا‬
. ‫اﻹﺳﻌﺎف‬ ‫ﺳﯾﺎرة‬ ‫ﺑواﺳطﺔ‬ ‫اﻟطوارى‬ ‫إﻟﻰ‬ ‫ﻧﻘﻠﮭﺎ‬ / ‫ﻧﻘﻠﺔ‬ ‫اﻟﻣدرﺳﺔ‬ ‫ﻹدارة‬ ‫اﻟﺻﻼﺣﯾﺔ‬ ‫أﻋطﻰ‬ ‫ﻓﺎﻧﻰ‬ ‫ﻋﻧﻰ‬
o ‫اواﻓق‬
o ‫اواﻓق‬ ‫ﻻ‬
: ‫اﻟﺳﺑب‬ ‫ذﻛر‬ ‫ﯾرﺟﻰ‬ ‫اﻟﻣواﻓﻘﺔ‬ ‫ﻋدم‬ ‫ﺣﺎﻟﺔ‬ ‫ﻓﻰ‬
.....................................................................
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(‫اﻟرﺻﺎص‬ ‫ﻗﻠم‬ ‫إﺳﺗﺧدام‬ ‫ﻋدم‬ ‫)ﯾرﺟﻰ‬ ‫اﻟطﺎﻟﺑﺔ‬ / ‫اﻟطﺎﻟب‬ ‫أﻣر‬ ‫وﻟﻰ‬ ‫ﺗوﻗﯾﻊ‬
........................................................ .: ‫اﻻﺳــــــــــم‬
......................................................... : ‫اﻟﻘراﺑﺔ‬ ‫ﺻﻠﺔ‬
.......................................................... : ‫اﻟﮭـﺎﺗف‬ ‫رﻗم‬
........................................................... : ‫اﻟﺗﺎرﯾـــــــﺦ‬
........................................................... : ‫اﻟﺗــــوﻗﯾـــﻊ‬
‫ﻋﻧﮫ‬ ‫ﯾﻧوب‬ ‫ﻣن‬ ‫ﺗوﻗﯾﻊ‬ ‫ﻋﻠﻰ‬ ‫اﻟﺣﺻول‬ ‫ﻣن‬ ‫ﻓﻼﺑد‬ ‫ﺳﺑب‬ ‫ﻻى‬ ‫اﻟﻣواﻓﻘﺔ‬ ‫ﻧﻣوزج‬ ‫ﻋﻠﻰ‬ ‫اﻷﻣر‬ ‫وﻟﻰ‬ ‫ﺗوﻗﯾﻊ‬ ‫ﺗﻌذر‬ ‫إذا‬
. ‫اﻻﻗﺎرب‬ ‫ﻣن‬
( ‫اﻟرﺻﺎص‬ ‫ﻗﻠم‬ ‫اﺳﺗﺧدام‬ ‫ﻋﻧدم‬ ‫ﻟﻠﻣواﻓﻘﺔ)ﯾرﺟﻰ‬ ‫اﻟﻣﺧول‬ ‫اﻟﺷﺧص‬ ‫ﺗوﻗﯾﻊ‬
........................................................ .: ‫اﻻﺳــــــــــم‬
......................................................... : ‫اﻟﻘراﺑﺔ‬ ‫ﺻﻠﺔ‬
.......................................................... : ‫اﻟﮭـﺎﺗف‬ ‫رﻗم‬
........................................................... : ‫اﻟﺗﺎرﯾـــــــﺦ‬

8. 6/15/2019 Digital Campus -->Online Admission --> Admission Form Entry
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9. 6/15/2019 Digital Campus -->Online Admission --> Admission Form Entry
ict.adiswathba.com/DCWeb/form/jsp_onlineAdmission/AdmissionFormPrintableView_ADIS1.jsp?printFlag=Y&portalFlag=appFormDownload&form_n… 9/10

10. 6/15/2019 Digital Campus -->Online Admission --> Admission Form Entry
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