Admission Form

Step-1 of 4

Name of Child:

Gender:

Father's Name:

Mother's Name:

Guardian's Name (if not staying with parents):

Father's Profession:

Mother's Profession:

Guardian's Profession:

Permanent Address:

Select permanent address district:

Select permanent address block:

Present Residence:

Select present address district:

Select present address block:

Date of Birth:

Aadhaar Number:

Contact Number:

Is the child a CWSN (Children With Special Needs)?

Please identify the type of Special Need:

Does the child belong to the Economically Weaker Section (EWS) category as per the government guidelines?

Does the child fall under any of the Disadvantage Group, identified by the Govt?

Is the child an orphan?

Is the child HIV affected/infected?

Is the child a Migrated Child?

Is the child a Street Child?

Caste:

Annual Income of Family (in Rs.):

Account Number:

Account Holder Name:

Bank Name:

Branch Name:

IFSC Code:

Samagra Shiksha Assam