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HALISAHAR PRIMARY SCHOOL

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: _____________________________