STUDENT ADMISSION FORM

School UDISE Code:* _____________________ Session:* _____________________

Admission number:* _____________________ Date of admission:* _____________________
Class of admission:* _____________________ Section:* _____________________

If the student was studying in another school, please capture the following information, if available:
Unique Student ID: _____________________ TC Number: _____________________

Please enter names in ALL CAPS as first name, middle name, last name
Student Name:* ______________ ______________ ______________
Father's/ Guardian's Name:* □ Mr □ Dr □ Prof ______________ ______________ __________ □ check if guardian

Mother's Name:* □ Mrs □ Ms □ Dr □ Prof ______________ ______________ __________

Student's habitation/ locality:* _____________________ Gender:* □ Male

(tick any one) □ Female
□ Transgender

Aadhaar Number: _____________________ Aadhaar type: □ UID □ VID □ EID

(tick any one)

If Aadhaar not available, mention □ Aadhaar not registered

the reason: □ Aadhaar registra on not possible (leprosy, blindness etc.)
(tick any one) □ Aadhaar registered but not yet received

Mother tongue:* □ Odia □ Bengali □ Assamese Religion:* □ Hindu □ Muslim □ Chris an

(if other, enter code from page 2) □ Urdu □ Hindi □ Telugu □ Sikh □ Buddhist □ Parsi
□ Other _________ □ Jain □ Others

Social category:* □ General □ SC

(tick any one) □ OBC □ ST
□ Other
ST sub-category:*
□ 1-Bagata □ 2-Baiga □ 3-Banjara □ 4-Bathudi □ 5-Bho ada □ 6-Bhuiya □ 7-Bhumia □ 8-Bhumij □ 9-Bhunjia □ 10-Binjhal
□ 11-Binjhia □ 12-Birhor □ 13-Bonda Poraja □ 14-Chenchu □ 15-Dal □ 16-DesuaBhumij □ 17-Dharua □ 18-Didayi □ 19-Gadaba
□ 20-Gandia □ 21-Ghara □ 22-Gond □ 23-Ho □ 24-Holva □ 25-Jatapu □ 26-Juang □ 27-Kandha Gauda □ 28-Kawar □ 29-Kharia
□ 30-Kharwar □ 31-Khond □ 32-Kissan □ 33-Kol □ 34-Kolah □ 35-Kolha □ 36-KoliMalhar □ 37-Kondadora □ 38-Kora □ 39-Korua
□ 40-Ko a □ 41-Koya □ 42-Kulis □ 43-Lodha □ 44-Madia □ 45-Mahali □ 46-Mankidi □ 47-Mankirdia □ 48-Matya □ 49-Mirdhas
□ 50-Munda □ 51-Mudari □ 52-Omanatya □ 53-Oraon □ 54-Parenga □ 55-Paroja □ 56-Pen a □ 57-Rajuar □ 58-Santal □ 59-Saora
□ 60-Shabar Lodha □ 61-Soun □ 62-Tharua

Type of disability: * □ Not Applicable

□ 1-Blindness □ 2-Low-vision □ 3-Hearing impairment (deaf/hard of hearing) □ 4-Speech and Language disability
□ 5-Locomotor Disability □ 6-Mental Illness □ 7-Specific Learning Disabili es □ 8-Cerebral palsy □ 9-Au sm Spectrum Disorder
□ 10-Mul ple Disabili es including deaf blindness □ 11-Leprosy Cured persons □ 12-Dwarfism □ 13-Intellectual Disability
□ 14-Muscular Dystrophy □ 15-Chronic Neurological condi ons □ 16-Mul ple Sclerosis □ 17-Thalassemia □ 18-Hemophilia
□ 19-Sickle Cell disease □ 20-Acid A ack vic m □ 21-Parkinson's disease

Does the child belong to BPL?* □ Yes Does the child belong to a □ Yes
(tick any one) □ No disadvantaged group:* □ No

Is the child homeless?* □ Yes Has the child opted for □ Hostel
(tick any one) □ No hostel or dayboarding?* □ Day Boarder
□ Not Applicable (tick any one)

Mobile number:* _____________________ Email address:* _____________________

(Student's or Parent's) (Student's or Parent's)

All fields marked with * are mandatory for collection Page 1 of 2

 STUDENT ADMISSION FORM

Student bank account number: _____________________ IFSC code: _____________________

Prior status of the student:* □ Le out during last year’s upda on

(tick any one) □ Dropped out before last academic year
□ Shi ed to other school during last year with or without TC
□ Came from other State. Men on State: _________________
□ Admi ed in age appropriate class in current year

_____________________ If admission in class 1, □ Same school

Class studied in the previous year:
previous year status:* □ Anganwadi/ECCE
Medium of instruction:* □ Odia □ Bengali □ Assamese □ Dropped out in the session
□ Urdu □ Hindi □ Telugu □ Out of school
(if other, enter code from page 2)
□ Other (men on) _________ □ Another school
□ Not Applicable
□ 12-Odia □ 4-Hindi □ 2-Bengali □ 17-Telugu □ 1-Assamese □ 18-Urdu □ 3-Gujara □ 5-Kannada □ 6-Kashmiri

Stream (class 11 & 12) □ Arts □ Science □ Commerce □ Voca onal □ Others

All fields marked with * are mandatory for collection Page 2 of 2