CTS-F-02

VINIMAY TRUST’S COOMIBEN BABUBHAI SHAH TARUN SADAN

APPLICATION FOR ADMISSION
(application through a residential child welfare institution)
1. Name:
First Name

Middle Name

Surname

2. Date of birth date month year

3. Proof Of Date Of Birth Birth Certificate Yes / No School Leaving Certificate Yes / No
4. Date of admission to the present institution
5a. Caste status: SC / ST / NT / OBC / others
5b. Caste certificate available? Yes / No
6. Details of Family and/or any supporters

7a. Education academic (including name of authority issuing certificate)

7b. Education technical (including name of authority issuing certificate)

8. Health: Any medical history to be kept in mind in future: (surgery, medical condition
needing continued medication e.g. heomophilia): YES / NO
If yes, details:

--- Continued.
 CTS-F-02(Contd.)

9a. Any unhealthy habits? (tobacco, drugs etc.): YES / NO

If yes, details:

9b. Undergone any de-addiction program? YES / NO

If ’yes’, details:

10. Was in conflict with law any time? YES / NO

If ’yes’, details:

11. Details of stay in different child welfare institutions

SNo. Name and address of CWI Period of Stay

12. Any job experience? YES / NO

If yes, details:

13. Any savings: YES / NO

If yes, details: amount, where kept etc.

14. Certified that the above details are true to the best of my knowledge and belief.

Signature, name and stamp of the Head of the institution.

 CTS-F-03
VINIMAY TRUST’S COOMIBEN BABUBHAI SHAH TARUN SADAN
APPLICATION FOR ADMISSION
(Direct application by an ex-student of a residential child welfare institution)
1. Name:
First Name
Middle Name
Surname
2. Date of birth date month Year
3. Proof Of Date Of Birth Birth Certificate Yes / No School Leaving Certificate Yes / No
4a. Date of leaving the last institution:

4b. Reason for leaving the last institution:

4v. What have you been doing since you left your last institution?

4d. What are you doing at present? Studying, working etc.

4e. Present address and telephone no.

5a. Caste status: SC / ST / NT / OBC / others

5b. Caste certificate available? Yes / No
6. Details of Family and/or any supporters

7a. Education academic (including name of authority issuing certificate)

7b. Education technical (including name of authority issuing certificate)

.8. Health: Any medical history to be kept in mind in future: (surgery, medical condition needing
continued medication e.g. heomophilia): YES / NO
If yes, details:

--- Continued
 CTS-F-03(Contd.)

9a. Any unhealthy habits? (tobacco, drugs etc.): YES / NO

If yes, details:

9b. Undergone any de-addiction program? YES / NO

If ’yes’, details:

10. Was in conflict with law any time? YES / NO

If ’yes’, details:

11. Details of stay in different child welfare institutions

SNo. Name and address of CWI Period of Stay

12. Any job experience? YES / NO

If yes, details:

13. Any savings: YES / NO

If yes, details: amount, where kept etc.

14a. Certified that the above details are true to the best of my knowledge and belief.
14b. I am enclosing certificates confirming my periods of stay in the last two child welfare
institutions (where applicable), or, the last child welfare institution in which I stayed
14c. I am enclosing reference letters of two respectable persons with whom I was in contact after
leaving my last child welfare institution.

Signature and name of the applicant