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Sibanya Milestone Bridge School
Building Bridges to Bright Futures

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Admission Application Form

Sibanya Milestone Bridge School — Bridge to Mainstream Education

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SIBANYA MILESTONE BRIDGE SCHOOL

(A Unit of Sibanya Social Welfare Foundation)  |  CIN: U88100OD2023NPL042376

House No. 59, 1st Floor, Brahma Nagar, 2nd Lane, Berhampur-760001  |  +91 7377040392

1
Student Information
300 × 400 px | JPG, PNG or WebP
2
Parent / Guardian Details

Father's Details

Mother's Details

3
Developmental Information — Any Previous Diagnosis?
4
Current Concerns — Tick if applicable
5
Medical Information
6
Educational Information
7
Therapy Information — Is the child currently receiving:
8
Emergency Contact Details
9
Assessment (To be filled by school)
10
Admission Required For *
Supporting Documents (Optional)
Birth cert, medical reports, etc. PDF or image, max 5MB
Declaration

I hereby declare that the information provided above is true and correct to the best of my knowledge. I understand that any false information may result in cancellation of admission.

A PDF copy will be generated after submission