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ADMISSION FORM
ISWARIPUR PRIMARY SCHOOL (Kalyani – II Circle)
PO. Chandamari. DIST. Nadia
U-DISE Code: 19101612301 Student Code:
A. Basic Information:
1. Name:
2. DOB: 3. Birth Regn. No:
4. Gender: Affix Passport size photograph
5. Social Category: 6. Religion: 7. Mother Tongue:
8. Nationality: 9. AadhaarNo. :
10. Blood Group: 11. Health ID:
12. Identification Mark:
B.Educational Information:
1. Academic Year: 2. Admission No: 3. AdmissionDate:
4. Present Class: 5. Present Roll No: 6. Present Stream:
7. Previous Class: 8. Previous Roll No: 9. Previous Stream:
10. Medium:
10. If studying in class 1, status of previous year:
12. No.of day’s child attended school:
C.Contact Information:
1. Address:
2. Locality: 3. District:
4. Block/Municipality: 5. Panchayat:
6. Post Office: 7. Police Station:
8. Pin Code: 9.Contact No.
D.Guardian’s Details:
1. Father’s Name: 2. Mother’s Name:
3. Guardian’s Name:
4. Relationship (with Guardian): 5. Annual Family Income:
6. Guardian’s Qualification:
E.Guardian’s Contact Information:
1. Address:
2. Habitation or Locality:
3. District:
4. Block/Municipality:
5. Panchayat: 6.Post Office: 7.Police Station:
8. Pin Code: 9.Contact No.:
F. Other Information:
1. BPL Status: (If Yes): 2. BPLNo.
3. Children with special need: If Yes, 4.Type of Disability:
G.Facilities:
1. Disadvantaged Group: (Y/N) 2. Getting free education as per RTE Act: (Y/N)
3. Whether the child is Homeless: (Y/N) 4. No of Uniform Sets Received: (Y/N)
5. Complete set of free books: (Y/N) 6. Free Transport facilities: (Y/N)
7. Free Escort Facility: (Y/N) 8. Free Hostel facility: (Y/N)
9. Hostel Type: (Y/N) 10. Hostel Schemes: (Y/N)
11. Special Training Facility: (Y/N) 12. Remarks: (Y/N)
13. CWSN Facility Received: (Y/N) 14. Free Bicycle: (Y/N)
15. Free Shoe: (Y/N) 16. Free Exercise Book: (Y/N)
H. Bank Details:
1. Bank Name:
2. Branch Code:
3. IFSC:
4. Account Number:
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Signature of Head of the Institution