Basic Information:
1.Name: ..................................................................................................................................................
2.DOB: ................................................................... 3.Birth Regn. No: ................................................
4.Gender: MALE / FEMALE / TRANSGENDER 5.Social Category:................................................
6.Religion: .............................................................. 7.Mother Tongue: ................................................
8.Nationality: ........................................................... 9.AadhaarNo. : ...................................................
10.Blood Group: ...................................................... 11.Health ID: ........................................................
12.Identification Mark: ______________________________________________________________
Educational Information:
1.Academic Year: ...................................................... 2. AdmissionNo: ..................................................
3.AdmissionDate: ....................................................... 4.Present Class: ..................................................
5.Present Section: ....................................................... 6.Present Roll No: ...............................................
7.Present Stream: ....................................................... 8.Previous Class: .................................................
9.Previous Section: .................................................... 10.Previous Roll No: ..............................................
11.Previous Stream: ................................................... 12.Medium: ...........................................................
13.If studying in class 1, status of previous year:____________________________________________
14.No.of days child attended school: ..........................................................................................................
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. : ________________________________________________________________________
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:______________________________________________________________
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.:____________________________________________________________________________
Other Information:
1.BPL Status: YES / NO If Yes 2.BPLNo.: _____________________________________
3.Children with special need: YES / NO If Yes 4.Type of Disability: _____________________________