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31 views

Form With Logo

Uploaded by

karanth7047
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Future Begins Here...

Naya Gaon, Chainpur, Siwan-841203


General Profile

1. Name of Student :
PHOTO

Aadhaar No. :
2. Name of Father :

PHOTO
Aadhaar No.
:
3. Name of Mother :

PHOTO
Aadhaar No. :
(Note :- Name of the Student, Parents and Date of Birth is not changeable.)

4. Address (Permanent) : Village - .………………………………….. P.O. - …………………………….

P.S. - …………………………… Dist. - ……………………… Pin code :

Contact No.
5. Contact (Alternative)
No.
6. Email ID : .…………………………………………………………………..
9. Sex : M F
7. Date of Birth : 8. Blood Group :

10. Mother tongue of the student: Hindi-Bhojpuri Hindi-Hindi English-English


( If any other, mention mother tongue ) : ……………………………………….

11. Whether Antyodaya Anna Yojana (AAY) beneficiary? Yes No

13. Whether CWSN? Yes No * If yes, (a) Type of impairment (code) : ……………………
(b) Disability percentage (in %) : …………

17. Minority Group : Muslim Christian Sikh Buddhist


Parsi Jain NA
D D M M Y Y Y Y

12. Whether belongs to EWS/Disadvantaged Group? Yes No

14. Whether BPL beneficiary? Yes No

15. Whether the student is Indian National? Yes No

16. Social Category : General SC ST OBC EBC


Enrollment Profile
1. (a) Admission No. : …………………..… (b) Admission Date : D D M M Y Y Y Y

2. Permanent Education Number (PEN) :


…………………..…
3. (a) Class : …………. (b) Roll No. : …….. (c) Section : ……… (d) House : ………………

4. Medium of Instruction : ……………………

5. Language Group studied by the student : ………………………………


6. Status of student in previous Academic Year of schooling : (Choose Below)
………………………………0
(a) Studied at current/same school. (b) Studied at other school.
(c) Angadwadi/ECCE Center. (d) None/Not studying.
7. Grade/Class studied in the previous/last Academic Year : ……………
………………………………
8. Admitted/Enrolled under : Section 12 of the RTE Disadvantaged Group
7. Ad Persons with Disability (PWD) EWS Others
9. In the previous class studied – Result of the examination : (Choose Below)
Promoted/Passed Not promoted/Not passed/Repeater Promoted/Passed without
examination
10. In the previous class studied – Marks obtained (in percentage) : ………….
11. No. of days student attended school (in previous academic year) : …….……

Facility Profile

1. Whether student has been screened for Specific Learning Disability (SLD) : Yes No

2. Whether student has been screened for Autism Spectrum Disorder (ASD) : Yes No

3. Whether student has been screened for Attention Deficit Hyperactive Disorder (ADHD) : Yes No

4. Has the student been identified as a Gifted/Talented? Yes No

5. Does the student appeared in any State Level Competition / National Level Competition / Olympiad?
Yes No
6. Does the student participate in NCC / NSS / Scouts and Guides? Yes No

7. Whether student is capable of handling digital devices including the internet? Yes No

8. (a) Student’s Height (in CMs) : ……… (b) Student’s Weight (in KGs) : ……….

9. Approximate Distance of student’s residence to school : Less than 1 km Between 1-3 km


9. Approximate Distance of student’s residence to school : Between 3-5 km More than 5 km
10. Completed Highest Educational Level of Father : ………………………

11. Completed Highest Educational Level of Mother : ………………………

12. Any special instruction to the school : ………………………………………………………………………

Student’s Signature
1. Kindly :
attach following Father’s
documents Signature
along with :
the appropriate form. Mother’s Signature :
(A) Mandatory
(i) Student’s Aadhaar Card
(ii) Student’s Birth Certificate
(iii) Father’s Aadhaar Card
(iv) Mother’s Aadhaar Card

(B) If required
(i) Antyoday Yojna Beneficiary Card
(ii) EWS/Disadvantaged Group Certificate
(iii) EWSN Certificate
(iv) BPL Beneficiary Card
(v) Social Category Certificate

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