KITTUR RANI CHANNAMMA RESIDENTIAL SAINIK SCHOOL

FOR GIRLS, KITTUR - 591 115. KARNATAKA [INDIA] Std VI-XII

[Member IPSC, Affiliated to Central Board of Secondary Education New Delhi]
School Code No. 45438, Affiliation No. 830488
Ph No.08288-234608, Cell : 8123409432, 9986652690 E-mail : kittursainikschool@gmail.com,
shivukotagi27@gmail.com, Website : www.kittursainikschool.in
“Preparing Responsible and Dedicated Citizens of Tomorrow”
ADMISSION NOTIFICATION
ALL INDIA ENTRANCE EXAMINATION FOR ADMISSION
To Class VI - Academic Year 2022-2023
Aim : Kittur Rani Channamma Residential Sainik School for Girls is being run on the lines of Sainik [Military] School
with the primary aim of empowering the Nation with enlightened, confident women of 21st century.
Curriculum : 10+2 System of CBSE [Science Stream].
Applications are invited in the prescribed form for admission of Girls to Standard VI for the Academic Year 2022-2023.
Admission is subject to qualifying in the All India Entrance Examination followed by Interview, Physical Fitness Test
and Medical Examination conducted by the Institution.
EXAMINATION DATE : January 30, 2022 (Sunday), Medium of Examination: Kannada OR English
EXAMINATION CENTRE : KITTUR, VIJAYAPUR, BENGALURU, KALABURAGI [Karnataka only]
AGE : Candidatesth born between June 1st, 2010 and May 31st, 2012 and having passed
Standard V are eligible for admission.
FEE STRUCTURE : Approximately Rs.1,90,600 /- per annum [Inclusive of lodging, boarding, uniform and
other deposit]. Kit and clothing items will be charged extra.
SCHOLARSHIP : Merit Scholarship as per Government of Karnataka Scholarship Scheme will be awarded only to
the eligible girls of Karnataka Native / Domicile. Girls who are awarded merit scholarship will
be required to persue their education in the school up-to class XII [Science Stream]
failing which full Scholarship amount received by the girl will be recovered at the time of
issue of Transfer Certificate.
RESERVATION : Two seats each are reserved for candidates coming under Kittur Hobli, Defence Personnel
Dependent and maximum three seats from National Bravery Award Winners quota.
INTERVIEW : Only candidates who qualify in the written test will be called for interview as per order
of merit in written test and availability of vacancies. Interview will be held at Kittur only.
The interview would comprise the following :-
[a] Physical Fitness Test : It includes 1 km Run, Horizontal & Vertical Jump to attain qualifying
standards, [b] Medical Examination : By Govt. Doctors only, [c] Interview by the Selection Board :
The final order of merit will be prepared by adding the marks secured in the interview to the marks
secured in the written entrance test.
Sale of Prospectus cum Application form : D.D. for Rs. 2,000/- for General Category candidates and
Rs. 1,600/- for SC/ST candidates [by producing authentic Caste Certificate]. Sale of Prospectus cum
Application forms will start from November 9th 2021 to December 25th 2021. Prospectus cum
Application form can also be obtained after December 26th up to January 10th 2022 on payment of
Rs. 2,000/- and additional penalty of Rs. 500/-(Total 2500/-). Application can be collected by hand from
the office on payment through D.D.
LAST DATE FOR SUBMITTING DULY FILLED APPLICATION FORM
31st December, 2021 [without penalty], and up to 15th January 2022 [with penalty].
Note : Prospectus cum Application form can also be downloaded from the School Website and duly filled and
submitted along with DD, value as above in favour of “Principal, KRCRSSG, Kittur” payable at Kittur.
Banks : Canara/SBI (Kittur Branch IFSC Codes: Canara-CNRB0010514, SBI-SBIN0013140.)
For online payment please visit our School Website : www.kittursainikschool.in
ADMISSION ON FULL FEE PAYMENT SCHEME : The candidates who are low in the order of merit [written test +
interview] for admission to the School may be considered in case vacancies exist on Full Fee Payment (FFP)
Scheme. Parents are requested to give their willingness in the application form for necessary consideration by
the School. Conversion of Merit to FFP is NOT automatic ; written request is mandatory.
SALIENT FEATURES
[A] International Education/Exchange Programme for Staff and Students : Under the Trilateral
Memorandum of Understanding between College of Education, Saginaw Valley State University [SVSU],
USA & Carrollton Public School, Michigan, USA including visit to USA by selected Staff as well as
Students, and reciprocal visit by the staff as well as students of these USA based Institutions to Kittur on year to
year basis : Dr. David Cline, is the Co-oridinator - SVSU / KRCRSSG Programme , University Center,
Michigan - 48710, USA, [B] Special Coaching Classes : Regular and rigorous coaching is organized for
students appearing for JEE / NEET etc by experts in the field through Educational Partnership with
Hanchinmani Classes, Dharwad, [C] NCC Training : NCC Training is compulsory, [D] Guides for Girls,
[E] Horse Riding, Swimming and other sports activities including Yoga and Meditation / Prayer, [F] NDA
Training
NOTE : <School authority reserves the right to change the pattern of examination, admission criteria and contents of the
question papers. < School is not responsible for non-receipt / delayed receipt of communications [Prospectus, Hall Tickets
and Results etc].<Hall Tickets will be sent by Ordinary Post only < Submission of Caste & Category, Kittur Hobli and
Defence Certificates [attested photo copies] of the candidate, if applicable, shall be attached to the filled application form,
failing which the candidate shall be considered under General Category.< Fees once paid / remitted will not be refunded
under any circumstance. < False Income / Caste Certificate may lead to rejection of candidature< Latest Caste / Category
and other certificate need to be submitted.
Ofce Hours: School office functions between 9-00 A.M. to 1-30 P.M. and 3-00 P.M. to 5-30 P.M.
from Tuesdays to Saturdays and between 9.30A.M. to 1.30P.M on Mondays.
Sd/- Sd/- Sd/- Sd/-
Col R. S. Khatri [Retd] Dr. David Cline, Ph.d.[USA] Sri Mahantesh S. Koujalagi Dr. Mahendra S. Kanthi,
Principal Professor, College of Education B.Com., LLB [Spl.], MLA Ph.D[UK / USA]
K.R.C.R.S.S.G., KITTUR. Saginaw Valley State University Member Secretary Chairman
University Centre, Michigan [U.S.A.] K.R.C.M.C., KITTUR. K.R.C.M.C., KITTUR.
 Appendix - A APPLICATION FORM FOR ADMISSION TO STANDARD VI Application No. (For Office use only)

C£ÀħAzsÀ - ‘J’ 6£ÉAiÀÄ vÀgÀUÀwUÁV ¥ÀæªÉñÀ Cfð £ÀªÀÄÆ£É Cfð ¸ÀASÉå :

KITTUR RANI CHANNAMMA RESIDENTIAL SAINIK SCHOOL FOR GIRLS, KITTUR-591 115
Dist : Belagavi Ph : 08288-234608 / 234605 Karnataka State
E-mail: kittursainikschool@gmail.com, principalkittursainikschool@gmail.com,
Website: www.kittursainikschool.in
CBSE Affiliation QvÀÆÛgÀÄ gÁt ZÀ£ÀߪÀÄä ¨Á®QAiÀÄgÀ ¸ÉʤPÀ ªÀ¸Àw ±Á¯É, QvÀÆÛgÀÄ.
No. : 830488
School Code : 45438 Academic Year : 2022-23 / ±ÉÊPÀëtÂPÀ ªÀµÀð : 2022-23

Details of Registration fee remitted / ¸ÀAzÁAiÀÄ ªÀiÁrzÀ £ÉÆÃAzÀt ±ÀÄ®ÌzÀ «ªÀgÀ (For office use only):
DD / Online Payment Receipt No. _________________School Receipt No. _________ Amount : _________________

1. Center where the Candidate wishes to take the Entrance KITTUR VIJAYAPUR
Examination (Please R Tick mark any one ) C¨sÀåyðAiÀÄÄ QvÀÆÛgÀÄ «dAiÀÄ¥ÀÄgÀ
EZÉÒ¥ÀqÀĪÀ ¥ÀæªÉñÀ ¥ÀjÃPÁë PÉÃAzÀæ (zÀAiÀÄ«lÄÖ R UÀÄvÀÄð ªÀiÁrj) BENGALURU KALABURAGI
¨ÉAUÀ¼ÀÆgÀÄ PÀ®§ÄgÀV
2. Medium in which the Candidate wishes to take the KANNADA ENGLISH
Entrance Examination( PleaseRTick mark any one ) PÀ£ÀßqÀ EAVèõÀ
C¨sÀåyðAiÀÄ EaÒvÀ ¥ÀæªÉñÀ ¥ÀjÃPÉëAiÀÄ ¨sÁµÁ ªÀiÁzsÀåªÀÄ
(zÀAiÀÄ«lÄÖ R UÀÄvÀÄð ªÀiÁrj)
3. Full Name of the Candidate in BLOCK LETTERS [as per school records] zÀ¥Àà CPÀëgÀUÀ¼À°è C¨sÀåyðAiÀÄ ¥ÀÆtð ºÉ¸ÀgÀÄ [±Á¯ÉAiÀÄ
zÁR¯ÉAiÀÄ°è EgÀĪÀAvÉ]

4 Guardian’s Name & Relationship with the Candidate ( if both the parents are not alive) ¥ÉÆõÀPÀgÀ ºÉ¸ÀgÀÄ ªÀÄvÀÄÛ
C¨sÀåyðAiÉÆA¢V£À ¸ÀA§AzsÀ (¥Á®PÀgÀÄ fëvÀ«gÀzÀ ¥ÀPÀëzÀ°è ªÀiÁvÀæ)
a. Father’s / Guardian’s Occupation / vÀAzÉAiÀÄ/¥ÉÆõÀPÀgÀ ªÀÈwÛ ___________________________________________
b.Mother’s Name / vÁ¬ÄAiÀĺɸÀgÀÄ__________________________________, Occupation / ªÀÈwÛ __________________

5. A. Candidates Date of Birth a) In figures / CAQUÀ¼À°è B. Blood Group*

C¨sÀåyðAiÀÄ ºÀÄnÖzÀ ¢£ÁAPÀ b) In words /CPÀëUÀ¼À°è gÀPÀÛzÀ UÀÄA¥ÀÄ
B. Place of Birth ºÀÄnÖzÀ ¸ÀܼÀ * gÀ.UÀÄ. £ÀªÀÄÆ¢¸ÀĪÀÅzÀÄ PÀqÁØAiÀÄ * Blood Group Compulsory
C. Aadhaar Card No.(Aadhaar seeding with mobile number)/(DzsÁgÀ PÁqÀð £ÀA. (ªÉƨÉÊ¯ï °APï ºÉÆA¢gÀ¨ÉÃPÀÄ))
Candidate :_______________________________, Father _____________________________, Mother ______________________________

6. Candidate’s Religion /C¨sÀåyðAiÀÄ zsÀªÀÄð :____________________________, Caste / eÁw : _____________________

7. Category to which Candidate belongs (Whichever is SC / ¥À.eÁw * CAT-III A / ªÀUÀð-3 J *

applicable: Please attach relevant certificate, If caste
certificate is not produced then the caste will be automatically ST / ¥À.¥ÀAUÀqÀ * CAT-III B / ªÀUÀð-3 © *
considered as General) and pleaseRtick mark / C¨sÀåyðAiÀÄÄ CAT-I / ªÀUÀð-1 * Kittur Hobli / QvÀÆÛgÀÄ *
¸ÉÃjzÀ ªÀUÀð[zÀAiÀĪÀiÁr C£ÀéAiÀĪÁUÀĪÀ ªÀUÀðPÉÌ R ªÀiÁrj]
¸À A §A¢ü ¹ zÀ ¥À æ ª À i Át ¥À v À æ ª À £ À Ä ß ®UÀ w Û ¸ À ¨ É Ã PÀ Ä . E®è ¢ zÀ Ý ° è
CAT-II A / ªÀUÀð-2 J * DEFENCE / gÀPÀëuÁ *
«zÁåyðAiÀÄ£ÀÄß ¸ÁªÀiÁ£Àå ªÀUÀðPÉÌ ¸ÉÃjzÀ «zÁåyðAiÉÄAzÀÄ CAT-II B / ªÀUÀð-2 © * Personnel ¹§âA¢
GENERAL / ¸ÁªÀiÁ£Àå *
¥ÀjUÀt¸À¯ÁUÀĪÀÅzÀÄ. Bravery Awardee /
±ËAiÀÄð ¥Àæ±À¹Û «eÉÃvÀgÀÄ
(a) Does the candidate belongs to OBC Category
[If yes please attach relevent Certificates] YES NO

(b) Minority YES NO

(.c) Single Child YES NO

8. Candidate’s Mother Tongue /C¨sÀåyðAiÀÄ ªÀiÁvÀȨsÁµÉ :_________________________________________________

Page 1
 9. Parent’s Present Postal Shri / Smt :
Address (Compulsary) ²æÃ/²æêÀÄw :
¥Á®PÀgÀ CAZÉ «¼Á¸À : At / Post / Pincode /
ªÀÄÄPÁÌA : CAZÉ : ¦£ïPÉÆÃqï:
Mark Applicable
¸ÀÆPÀÛªÁzÀÄÝ DAiÉÄ̪ÀiÁr R Taluka /
vÁ®ÆPÀ :
District /
f¯Éè :
State
gÁdå :
Urban Rural Mobile / Land Line /
£ÀUÀgÀ UÁæ«ÄÃt zÀÆgÀªÁt ¹ÜgÀªÁt :
E-mail ID / «ÄAZÀAZÉ «¼Á¸À :

Father /vÀAzÉAiÀÄ ªÁ¶ðPÀ DzÁAiÀÄ gÀÆ. PA

10. Parent’s Total Income from all sources/ ¥Á®PÀgÀ ªÁ¶ðPÀ
DzÁAiÀÄ (J¯Áè ªÀÄÆ®UÀ½AzÀ): Mother /vÁ¬ÄAiÀÄ ªÁ¶ðPÀ DzÁAiÀÄ gÀÆ. PA

11. School and Standard in which Name of the School ___________________________________________

Candidate is Studying at present / C¨sÀåyðAiÀÄÄ
Address ____________________________________________________
¥Àæ¸ÀÄÛvÀ ªÁå¸ÀAUÀ ªÀiÁqÀÄwÛgÀĪÀ ±Á¯É ªÀÄvÀÄÛ ªÀUÀð:
STD Code : _________________ Telephone : ______________________

12. Whether Candidate has appeared for the K.R.C.R.S.S.G Entrance Test
earlier / C¨sÀåyðAiÀÄÄ F ªÉÆzÀ®Ä QvÀÆÛgÀÄ gÁt ZÀ£ÀߪÀÄä ¨Á®QAiÀÄgÀ ¸ÉʤPÀ YES NO
ªÀ¸Àw ±Á¯É, QvÀÆÛgÀÄ E°è ¥ÀæªÉñÀ ¥ÀjÃPÉëUÉ ºÁdgÁVzÁݼÉAiÉÄ? ºËzÀÄ E®è

13. Did / Does Candidate have / has any close relatives Studying /
YES NO
Studied in this School / C¨sÀåyðAiÀÄ ¸ÀA§A¢üPÀgÀÄ F ±Á¯ÉAiÀÄ°è C¨sÁå¸À
ªÀiÁrzÁÝgÉAiÉÄÃ?/ªÀiÁqÀÄwÛzÁÝgÉAiÉÄÃ? ºËzÀÄ E®è

14. If yes, Name and years in KRCRSSG Kittur./ C¨sÀåyðAiÀÄ ¸ÀA§A¢üPÀgÀÄ F

±Á¯ÉAiÀÄ°è C¨sÁå¸À ªÀiÁrzÀÝgÉ, CªÀgÀ ºÉ¸ÀgÀÄ ªÀÄvÀÄÛ N¢zÀ ªÀµÀðUÀ¼ÀÄ
15. Are you ready to take Full Fee Payment seat, If no seat is available in
Merit Scholarship Scheme / CºÀðvÁ ¥ÀjÃPÉë [ªÉÄjmï ¸ÁÌ®gﶥï¹ÌêÀiï£À°è] YES NO
¥ÀæªÉñÀ zÉÆgÉAiÀÄzÉà EzÀÝ°è ¤ÃªÀÅ J¥sï.J¥sï.¦. CrAiÀÄ°è ¥ÀæªÉñÀ ¥ÀqÉAiÀÄ®Ä ºËzÀÄ E®è
¹zÀÝjgÀÄ«gÁ?.

CERTIFICATE BY THE PARENT & DECLARATION / ¥Á®PÀgÀ WÉÆõÀuÁ ¥ÀæªÀiÁt ¥ÀvÀæ

I Mr / Mrs._________________________________________________________________________ Father / Mother

of Kumari : ______________________________________________________Certify that my daughter IS NOT SUFFERING
FROM ANY CHRONIC DISEASE, COMMUNICABLE DISEASE, COLOUR BLINDNESS OR NIGHT BLINDNESS. I ALSO HERE
BY GIVE AN UNDERTAKING THAT, I WILL FURNISH ALL DETAILS OF OPERATIONS IF ANY, MY DAUGHTER HAS
UNDERGONE ALONG WITH NECESSARY DOCUMENT, AT THE TIME OF MEDICAL EXAMINATION.
I solemnly declare that the particulars furnished in the form above are true to the best of my knowledge and no information
is concealed. In the event of any of the above information being found incorrect at anytime I undertake to return the full amount of
scholarship [ if granted ] on demand and without demur and will have no objection to my daughter being immediately removed from
the rolls of the school.
I agree to submit any additional certificates / records asked for by the school in case required to substantiate statements
made by me in this application. Once admitted in the merit seat I will not withdraw my daughter from the school till she completes
her education upto XII Standard (Science Stream).
Place : .....................................
Signature of the Parent / Legal Guardian Affix latest
(Stamp Size)
Date : ...................................... Photograph of
Name in Full [Father / Mother] Father]
vÀAzÉAiÀÄ ¸ÁÖA¥ï
C¼ÀvÉAiÀÄ ¨sÁªÀavÀæ
Mobile No. : ___________________________ ®UÀwÛ¹
[N.B.: In case the Father is not alive, the Mother only and if both parents are not alive, the Guardian of the Child will fill and sign this application.]

Page 2
 STUDYING CERTIFICATE OF V STANDARD FROM PREVIOUS SCHOOL
F »AzÉ PÀ°AiÀÄÄwÛzÀÝ 5£ÉAiÀÄ vÀgÀUÀwAiÀÄ ªÁå¸ÁAUÀzÀ ¥ÀæªÀiÁt ¥ÀvÀæ
( ±Á¯ÉAiÀÄ £ÀA.1 gÀf¸ÀÖgï£À°è EgÀĪÀAvÉ zÁR°¸À¨ÉÃPÀÄ)
This is to certify that Kumari : ___________________________________________________________________daughter of
Mr/Mrs_____________________________________________________________ Is a bonafide student of this school,
studying in Standard: 5th (V). Her date of birth as entered in our school record is ___________________ [in
words]_______________________________________________________________________________________
Her caste is _____________________ Category is ____________________School DISE Code : _________________
Student Achievement Tracking System No. ________________________________
Affix latest
Mother Tongue : Seal and Signature of (Stamp Size)
Photograph of
Head of the Institution the Candidate
Place : C¨sÀåyðAiÀÄ ¸ÁÖA¥ï
Name in Full [ ] C¼ÀvÉAiÀÄ ¨sÁªÀavÀæ
Date : ®UÀwÛ¹
Incomplete application will not be accepted / C¥ÀÆtð CfðAiÀÄ£ÀÄß wgÀ¸ÀÌj¸À¯ÁUÀĪÀzÀÄ
(Note : Please fill up “A” if father is a native of Karnataka fill up “B” if father is domiciled in Karnataka) [not applicable for candidate from states other than Karnataka]

I, Mr. : ._______________________________________________________________ hereby declare that I am, father of

Kumari___________________________________________ and am a native of Village ________________________
A Taluk :________________________ Dist :_______________________ Karnataka State.

I, Mr. : ______________________________________________________________ hereby declare that I am, father of

B Kumari______________________________________and am domiciled in___________________________ Village
/Town ________________________ Taluk :______________________ Dist :__________________ Karnataka State

Place:....................... Date: ..................... Signature and Seal of Tashildar Signature of Parent / Legal Guardian
For Domicile, attested photocopy of documents to be enclosed as below.
a) Candidates should complete her education from 1st to 5th standard in the recognized school having DISE code in Karnataka State(Study Certificate)
b) Parents (Father/Mother) including candidate should be resident of Karnataka state for 5 years in the recent past( Domicile Certificate issued by
Revenue department, Government of Karnataka)

INCOME CERTIFICATE *
This is to Certify that Annual Income of Sri/Smt. _________________________________________________ Father / Mother / Legal

Guardian of Kumari______________________________________ who is an applicant for admission to Kittur Rani Channamma

Residential Sainik School for Girls, Kittur is as under on October 2021 as under
I. 1. Income of Father : Basic Salary : Per Month : ...............................
2. DA, ADA, CCA Conveyance Allowance, Deputation
Allowance, Special Allowance, Bonus etc., : Per Month : ...............................
3. Income from Immovable Property : Per Month : ...............................
II. 1. Income of Spouse Basic Salary : Per Month : ...............................
2. DA, ADA, CCA Conveyance allowance, Deputation
Allowance, Special Allowance, Bonus etc., : Per Month : ...............................
3. Income from Immovable Property : Per Month : ...............................
III. 1. Any other source of Income (Both Father & Mother) : Per Month : ...............................
Total Annual Income is Rs:.........................( in words )...........................................................................................
Place: .....................................
Date:...................................... Office Seal Tahasildar (Taluka Magistrate)

Page 3
 Appendix - B SPECIAL INSTRUCTIONS FOR CANDIDATES SEEKING ADMISSION TO CLASS-VI
C£ÀħAzsÀ -‘§’ Academic Year : 2022-23 ±ÉÊPÀëtÂPÀ ªÀµÀð : 2022-23

1. Medium of examination will be either in English OR Kannada, Question papers for Class VI will be supplied in the medium as indicated in the
application form.
2. Identical copies of recent passport size photographs taken on or after 1.10.2021 will be affixed on Application Form and Hall Ticket.
3. The photograph affixed on the Application Form must be attested by the Principal/Headmaster of the school in which the girl is studying. In case
of private school the same must be attested by a Gazetted Officer.
4. Identification Card (Appendix-C with details be properly filled in. The candidates Parent/Guardian should affix her signature on the photograph.
Write your latest Correspondence Address clearly on the envelops and send along with the filled in Application form.
5. Attach Certificate of Proof of Date of Birth, obtained from a recognized school in which you are studying. In case studying in an unrecognized
school, attach a Xerox copy of birth certificate obtained from the Registrar of Births and Deaths duly attested by a Gazetted Officer.
6. Attach attested Xerox copy of Caste Certificate in case of SC/ST candidate obtained from Tahsildar concerned, failing which candidature will be
rejected. Attach Aadhaar Card Xerox copies of the Candidate and both the Parents.
7. In case of Ex-service personnel, a certificate from the District Sainik Welfare Officer is to be attached for availing reservation Serving Defence
personnel are required to submit a service certificate from their Commanding Officer and proof of date of Birth extract from Service Register.
8. Applications without enclosing proof of Date of Birth and Caste Certificate will be rejected.
9. Only those girls who are within the age limits are eligible to apply. There is no relaxation of Age limits to any category.
10. Candidates who have appeared earlier in the Entrance Examination to Class VI are not eligible to re-appear in the Entrance Examination for the
same class.
11. Application found in order and duly completed in all respects ONLY will be registered and the Hall Ticket despatched.
12. Request for change of centre of examination or change in language will not be entertained at a later stage.
13. Full Postal Address, to which Identification Card and other communications are to be sent, must be furnished clearly in the Application Form and
on the enclosed Envelopes.
14. The school is not responsible for non-receipt / late receipt of communication due to postal faults / delays.
15. Parents / Guardians are requested not to contact any staff of the regarding any information about the entrance test is found trying to develop
vested interest for the favoring any admission the candidature will be disqualified.
16. Guidelines for Medical Examination :
Eye : Distant vision must be 6/6 for each eye with or without glasses. Myopia should not be more than 2.5 (i.e-2:5D) and
hypermetropia should not be more than 3.5 (i.e4-3.5D). She should not be colour blind. Surgical correction of Myopia is a permanent rejection.
Ear : She should be able to hear a forced whisper with each ear from a distance of 610 cms.
Heart : There should not be any kind of murmur in the heart.
Lungs : There should not be any evidence of past or present disease.
Skin : There should not be any dermatological contageous diseases.
General : There should not be any bodily deformity. She should not have chest deformity, polydactly etc.
17. No candidate will be admitted to the written examination unless she produces the Hall Ticket bearing her photograph and signature and seal of
the Principal / Head Master of the school in which the Girl is studying.
18. The envelope containing the application form should be super-scribed in bold letters as:
19. Results : The final results will be declared without taking the medical fitness into consideration. Admission will be offered only if the candidate is
declared medically fit by the competent authority. However, candidates declared unfit may appeal against the decision and in case the
candidate is declared fit by "Appeal Medical Board" she will be considered for admission in the school.
20. The school does not patronize any coaching institute / agent and the admissions will be made strictly in accordance with the merit, Medical
Fitness, Physical fitness of candidates.
21. Only those who have completed 10 years but not 12 years of age as on 1st June of the year of admission are eligible. For admission to
Class VI for 2022-23 the candidates should have been born between June 2010 and May 2012. Girls are admitted to Class VI according
to the seats available at the beginning of the year. The admission will be made on the basis of Entrance Examination. [Written Test and
Interview]
22. The written examination for class VI will be held as per the time table mentioned here under.

Date & Time Name of the Paper Max.Marks Remarks

Language Proficiency Test

30.01.2022 a) English 25 Question Cum Answer
10-00 AM b) Kannada / Hindi 25 Booklet will be
to General Mathematics (English /Kannada) 75 in one bunch
12-00 Noon I.Q. [Mental Ability] (English /Kannada) 75
Total 200

Page 4
 Application No. (For Office use only)
Appendix - C
C£ÀħAzsÀ - ‘¹’
HALL TICKET / ¥ÀæªÉñÀ ¥ÀvÀæ Cfð ¸ÀASÉå :

KITTUR RANI CHANNAMMA RESIDENTIAL SAINIK SCHOOL FOR GIRLS, KITTUR-591 115
Dist : Belagavi Ph : 08288-234608 / 234605 Karnataka State
E-mail: kittursainikschool@gmail.com, principalkittursainikschool@gmail.com,
Website: www.kittursainikschool.in
CBSE Affiliation
No. : 830488
QvÀÆÛgÀÄ gÁt ZÀ£ÀߪÀÄä ¨Á®QAiÀÄgÀ ¸ÉʤPÀ ªÀ¸Àw ±Á¯É, QvÀÆÛgÀÄ.
School Code : 45438 Academic Year : 2022-23 / ±ÉÊPÀëtÂPÀ ªÀµÀð : 2022-23
WRITTEN EXAMINATION FOR ADMISSION TO STANDARD VI 2022-23 SESSION
MERIT SCHOLARSHIP & FULL FEE PAYMENT EXAMINATION
6£Éà vÀgÀUÀwAiÀÄ 2022-23 £Éà ªÁ¶ðPÀ ¥ÀæªÉñÀPÁÌV °TvÀ ¥ÀjÃPÉë MERIT ªÀÄvÀÄÛ F.F.P. ¥ÀjÃPÉë
KCS / 151 / Trg / 22-23 Hall Ticket No. :
Q.ZÀ.±Á./151/vÀ/22-23 ¥ÀæªÉñÀ ¥ÀvÀæ ¸ÀASÉå : for office use only
Candidate Name / «zsÁåyð¤AiÀÄ ºÉ¸ÀgÀÄ Father’s Name / vÀAzÉAiÀÄ ºÉ¸ÀgÀÄ Surname / CqÀØ ºÉ¸ÀgÀÄ

1. Kittur Rani Channamma Residential Sainik School For Girls, Kittur-591115 3. Sainik School, Vijayapur
CENTRE / PÉÃAzÀæ

QvÀÆÛgÀÄ gÁt ZÀ£ÀߪÀÄä ¨Á®QAiÀÄgÀ ¸ÉʤPÀ ªÀ¸Àw ±Á¯É, QvÀÆÛgÀÄ-591115 ¸ÉʤPÀ ±Á¯É, «dAiÀÄ¥ÀÄgÀ
2. Shree Sarvajna High School, No.7 & 8, 14th Cross, 5th Main, 4. Sharanabasaveshwara Public School,
MC Layout, Nagarbhavi Road, Vijayanagar, Bengaluru - 560040 Kalaburagi, Ph : 08472-220738
Phone : 08288-234608, Cell : 8123409432, 9986652690 ±ÀgÀt §¸ÀªÉñÀégÀ ¥À©èPï ±Á¯É, PÀ®§ÄgÀV
²æà ¸ÀªÀðdÕ ¥ËæqsÀ±Á¯É, £ÀA. 7 ªÀÄvÀÄÛ 8, 14£ÉAiÀÄ CqÀØ gÀ¸ÉÛ, 5£ÉAiÀÄ ªÀÄÄRå gÀ¸ÉÛ, ¥sÉÆãï : 08472-220738
JªÀiï.¹. ¯ÉÃOmï, £ÁUÀgÀ¨Á« gÀ¸ÉÛ, «dAiÀÄ£ÀUÀgÀ, ¨ÉAUÀ¼ÀÆgÀÄ-560040
zÀÆgÀªÁt : 08288-234608, ªÉƨÉʯï: 8123409432, 9986652690

Medium (ªÀiÁzsÀåªÀÄ): / 1. Kannada / PÀ£ÀßqÀ 2. English / EAVèµï

Parents should indicate their choice by the R mark, where applicable. / ¥Á®PÀgÀÄ EaѹzÀ ªÀiÁzsÀåªÀÄ C£ÀéAiÀĪÁUÀĪÀzÀ£ÀÄß R ªÀiÁr UÀÄgÀÄw¹j.

Date of Examination (¥ÀjÃPÉëAiÀÄ ¢£ÁAPÀ) : 30-01-2022 [Sunday] / 30-01-2022 [¨sÁ£ÀĪÁgÀ], Time : 10-00AM to 12 -00 Noon
Examination Papers : 1) Language Proficiency Test / ¨sÁµÁ ¸ÁªÀÄxÀåð g a) English EAVèõï, b) Kannada / Hindi PÀ£ÀßqÀ/»A¢Ã
¥Àæ±Éß ¥ÀwæPÉUÀ¼ÀÄ : 2) General Mathematics / ¸ÁªÀiÁ£Àå UÀtÂvÀ, 3) I.Q. [Mental Ability] / ªÀiÁ£À¹PÀ §Ä¢Þ ¸ÁªÀÄxÀåð
INSTRUCTIONS (¸ÀÆZÀ£ÉUÀ¼ÀÄ):
1. The Candidate should reach the Examination Center with Father / Mother only before 8:00 AM. along with HALL TICKET, 2. Parents have to make their own arrangement
for breakfast for the candidate on the date of examination, 3. Candidate has to bring her own writing material like Ballpoint Pen & Pencil [Calculators , Compass Box, Mobile ,
Watch & Clip Board are not allowed], 4. The Candidate should not write her Hall Ticket Number anywhere. The question paper - cum Answer Booklet, given to the candidate
readily contains the hall ticket Number. Do not forget to check this, 5. Candidates should make their own arrangements for conveyance to the Examination center and back &
wear Normal Dress, 6. If the candidate makes any identification mark on the answer papers, her candidature will be withdrawn, 7. Candidate who qualify in the Entrance
Examination will be called for Viva - voice at Kittur on an appointed day, by sending the Call Letters, as per Merit List, 8. Results of unsuccessful candidates will not be
communicated to them in any way. No correspondences or query will be entertained in this connection, 9. Request for the change of center will not be accepted .
10. In view of Covid-19 protocol, candidates need to carry Face Mask, Hand Sanitizer and Transparent water bottle at the time of reporting for the examination
Center and maintain social distancing.

PRINCIPAL

IDENTITY CERTIFICATE (±Á¯ÉAiÀÄ ªÁå¸ÁAUÀzÀ ¥ÀæªÀiÁt ¥ÀvÀæ, ±Á¯ÉAiÀÄ £ÀA.1 gÀf¸ÀÖgï£À°è EzÀÝAvÉ zÁR°¸À¨ÉÃPÀÄ)

This is to certify that Kumari : _____________________________________________ daughter of Application No.

Mr/Mrs. _________________________________ is a bonafide student of this school, Studying in standard
: ________, Her Date of Birth as entered in our school record is __________________[ in words]
Hall Ticket No.
_________________________________________________ She belongs to __________ Caste and
for office use only
Sub-Caste ___________ as per our records, Her Mother Tongue is ___________________
School DISE Code :______________,Student Achievement Tracking System No.
Place:______________

Date:_______________ School Seal The Seal and Signature of Head of the School
with Phone and Mobile Number

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 SOME OF THE DOCUMENTS TO BE PRODUCED AT THE TIME OF ADMISSION
01. Caste Certificate from Taluka / Mandal Revenue Officer if belonging to SC / ST / OBC
02. Caste Certificate from employer
03. Caste Certificate in case of BC students
04. Nativity Certificate issued by the Taluka /Mandal Revenue Officer
05. Income certificate issued by the Taluka /Mandal Revenue Officer
06. Income certificate issued by the Employer for salaried persons
07. 06 Nos of latest Passport Size Photographs and 06 Nos Stamp Size Photographs of the Girl, Both Parents & Legal
Guardian and also Combined Group Photo of the Entire Family.
08. Adoption Deed (if applicable)
09. Certificate showing Blood group of the girls.
10. Demand Draft drawn in favour of the Principal KRCR Sainik School for Girls, Kittur, for fees as prescribed
11. Indemnity Bond / Risk Certificate
12. Affidavit and Certificate of Income duly signed by the parent
13. Certificate by Defense personnel regarding non receipt of any Scholarship.
14. Declarations by the Parent
15. Address Particulars
16. Study Details
17. Identity Certificate of Parent / Guardian in Duplicate.
18. TC/Proof of Date of Birth. If in Kannada, Parent has to certify the details duly translated into English and
submitted to school.
19. Agreement Bond of Non Judicial E Stamp of Rs. 100/- as per prescribed format.
20. Language Preference
21. Medical Certificate from District Surgeon including Medical History Sheet.
22. Transfer Certificate from previous School counter signed by B.E.O.
23. Marks Card from Previous School with DISE Code (District Information System for Educational Code) and STS
Number
24. CBSE Registration form
25. information for the Identity Card of Student, Father, Mother / Guardian with Photo.
26. Undertaking from the Candidate ( Anti ragging)
27. Undertaking from the Parent /Guardian
28. Attested Copies of Aadhaar Card of Candidate and both parents & PAN [For parent (s)]
29. Birth Certificate of the candidate issued by the Registrar of Births and Deaths(Attested Xerox Copy).
30. Latest Salary Certificate (Basic +DA) only for parents at the time of Admission if applicable.
31. Candidates belonging to SC / ST shall produce their latest Bank Pass Book, Caste Certificate & Parent’s Income
Certificates
32. Original Aadhar Card of the candidate.
33. Photocopy of PAN Card of the candidate
34. Photocopy of the Bank Account Pass Book. The candidate should be an account holder either in State Bank of
India or Canara Bank with KYC updated/ Aadhar seeding with mobile number being linked to the same bank
account.
Note: (a) The School will submit the bank details of only those Scholarship candidates (Merit Cases) to the
Government, who have made full fees payment. (b) The School is not responsible for delayed/ late depositing of
Scholarship amount in the Bank account of candidates- all cadets, FFP or Merit cases, are required to pay full fees as
requested by the School from time to time.

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