Class Gender Admission No.

1 M

No. 70, Chikkanayakanahalli, Off Doddakaneli, Sarjapura Road, Bangalore- 560 035
Email: admissions@[Link], Ph.: 6364013999 and 9513088861/62

Application form (Academic year______________)

2022-2023

Kindly note, we follow the ICSE curriculum.

This form should be filled in and returned to the school office within 10 days from the date of purchase
of the same.

a) Incomplete forms including those without a photograph and latest school report will
not be considered.
b) Submission of this form does not guarantee an interview call or admission. The School
Management Committee reserves the right to grant admission.
c) Your child should have completed 3 years 6 months as of 1st June for admission to Prep 1.
d) Kindly fill in the reference number for payment made for purchase of application
form……………………………………………………………………..
126504431200

e) Admissions will be on a first come first serve basis.

A. Student Information:
1. Name (in full, in capital letters) SAMANTH ARUNA KARTHIK

2. Date of Birth 12.03.2016 3. Gender M M/F

4. Place of Birth Bangalore

5. Nationality INDIAN Aadhaar No : Not yet available

6. Religion (required by Govt.) HINDU
7. Languages commonly spoken at home TAMIL, ENGLISH
8. Mother Tongue TAMIL
9. Language required as medium of instruction for our child ENGLISH
10. a) Admission sought into class 1 (First Standard)
b) Age at the time of proposed entry (June 1st) 6 years 3 months
11. Have you applied earlier for this child's admission to this school? Yes / No
If yes,
a) Year sought admission
b) Did you get admission? Yes / No

12. Particulars of previous schooling/daycare

(Please attach a copy of the latest available school report and mark sheet)
 Name of the School Place Date of Joining Date of Leaving Standard

Anokhi Montessori Bangalore August 2018 March 2020 Mont 1

Seven Senses Mont Bangalore June 2020 Presently Studying Mont 3

13. Brothers and sisters of the applicant

Name Age Gender Name of the School / College

Not applicable

14. If a sibling is also applying for admission into this school, please mention the child's
name and class to which admission is sought.
Not applicable

15. Name of any relatives, if any, who are studying or have studied in Prakriya, with dates
(please state their relationship to you).

Not applicable

16. Student Medical Details and Health Condition: (recent medical/doctor reports and
recommendations to be attached)
Blood Group: O+
Immunization status
BCG : Yes Measles : Yes
OPV : Yes MMR : Yes
DTP : Yes Typhoid : Yes

Booster for DPV : Yes Hepatitis B : Yes

a. If your child has an allergy, please specify below. ALLERGIES – THESE CAN INCLUDE
ALLERGIES TO INSECT STINGS, DRUGS, LATEX, FOOD (EG: NUTS, EGGS, PEANUTS) OR ANY
OTHER.
Allergy to None
Has a doctor diagnosed this allergy? Yes/No
Has your child been hospitalised with a severe allergic reaction or any
other allergy? Yes/No
If yes, which hospital?
Please list medication prescribed for this allergy -

Has your child been prescribed an adrenaline autoinjector (ie EpiPen®)? Yes/ No
 b. MEDICAL CONDITIONS OTHER THAN ALLERGIES (EG: ASTHMA, SEVERE ASTHMA, DIABETES,
EPILEPSY, FEBRILE SEIZURE) Please identify and provide details below of any other
medical condition for which your child is being treated. (If more than one condition or
insufficient space, please attach additional pages and include your answers)

Medical condition 1: Not applicable

Has a doctor diagnosed this condition? Yes/No
Has your child been hospitalised with this condition? Yes/No
If yes, which hospital?
Does your child have a documented action plan from a doctor? Yes/No
If yes, is this plan attached? Yes/No
Is your child taking prescribed medication for this condition? Yes/No
If yes, what is the prescribed medication?

c. Physical disability if any None

The school will require further details in relation to prescribed medication on enrolment.
Parents of children who require their child to be administered prescribed medication at
school must complete a written request and sign a declaration form. Failure on the part
of the parent to sign the declaration form shall result in the cancellation of admission
to your child.
17. Students with additional learning and support needs, including disability:

a) Any behavioral or other issues?

b) Have you noticed any kind of learning difficulty in your child? Have you done any
professional assessment? Please provide copies of assessment recently done (recent
reports).
Not applicable

B. Information about Parents /Guardian :

Please ensure that each parent (guardian in case parents are no more), who is
individually or jointly responsible for the student financially or otherwise, fills up the
information in the following pages.
1) To be filled by the mother (or guardian)
a) Name: Aruna Ganesh Ram
b) Relationship to the student: Mother / Guardian
c) Age: 36 years
 d) Professional /Educational Qualification:
(State the highest degree attained)

Details of Colleges / Universities attended:

Degree College / University Year of Graduation

MA Theatre Studies The Royal Central School of Speech and Drama, UK 2013

PG Marketing Chennai Business School 2007

BSc Visual Comm MOP Vaishnav College, Chennai 2006

e) Presently working at:

Name & Address of the Organisation Phone No. Designation Nature of Work

Interweave Consulting - Old Airport Road, 7760275275 Head-Innovations Diversity & Inclusion
Bangalore - 560017 in Inclusion

f) If self-employed/Owning own business:

State Nature of Work Phone No. Name & address of your Organisation

Theatre Director & Storyteller 7760275275 Visual Respiration Theatre Company, Domlur
Founder & Director Krishna Reddy layout,Bangalore - 560071

g) If working for an NGO:

State Nature of Work Phone No. Name & address of NGO

h) Does your employer provide any allowance / reimbursement of educational

expenses for your child? If so give details. Not applicable

2) To be filled by the Father (or guardian)

a) Name: Ravi Karthik Rajagopal
b) Relationship to the student: Father / Guardian
c) Age: 39 years
 d) Professional /Educational Qualification
(State the highest degree attained)

Degree College / University Year of Graduation

PGDBM IIM, Bangalore 2006

e) Presently working at:

Name & Address of the Organisation Phone No. Designation Nature of Work

ACT Fibernet 9611267367 Chief Marketing Marketing, Innovations

officer Customer Experience

f) If self-employed/Owning own business:

State Nature of Work Phone No. Name & address of your Organisation

g) If working for an NGO:

State Nature of Work Phone No. Name & address of NGO

h) Does your employer provide any allowance / reimbursement of educational

expenses for your child? If so give details. NO

i) Any other details considered important, but not covered above:

C. Financial information about parents / guardian:

Gross (pre-tax) annual income of the parents:
Mother / First guardian: 40 Lacs +

Father / Second guardian: 80 Lacs +

D. Addresses for communication:
Mother /guardian Aruna Ganesh Ram Father/ guardian Ravi Karthik Rajagopal

Address: C-901, Adarsh Palm Retreat Address: C-901, Adarsh Palm Retreat
Tower 1, Bellandur, Bangalore - 560103 Tower 1, Bellandur, Bangalore - 560103

Mobile: 7760275275 Mobile: 9611267367

Phone (Res): Phone (Res):

Phone (Off): Phone (Off):

E-mail: arunaganeshram@[Link] E-mail: ravikarthik25@[Link]

Mobile No. for sending SMS: 7760275275

E. To the Parent
Your responses to the following 3 questions will help us to understand the child better
and reach out to him / her with awareness and sensitivity. However, you may feel free
to confine your responses to your level of comfort and not feel obliged to disclose
information that you consider irrelevant in this context. Please be assured that this
would be treated as confidential.
a) If the guardian of the child is someone other than the father or mother, state the reasons
and background.

b) If the parents are separated or divorced, please indicate clearly the legal status in term
of custody and access to parents and the arrangements between the parents regarding
the visitation rights or any other rights in conformity with the orders of the legal
authority and school rules. In such cases (those in which one of the parents has visitation
rights or any other rights and the other parent has custody) both the parents should sign
the application form.
c) If the parents are separated or divorced, please indicate the person responsible for
payment of fee.
Not applicable
F. Understanding the parent:
We request you to answer the following questions to help us understand what you are
looking for. Your answers are important to us as we hope to understand if what the
school offers and what you are looking for are in the same direction.

a) What qualities do you see as important for your child in life?

We would love Samanth to be a caring and compassionate human being - to the world at large. We would
like Samanth to continue being curious and explore the world through his senses. If he is able to create
value to the world around him through his skills, qualities and attitude, that would be very satisfying.
We believe that Hardwork is key. Practice is progress. Conversations are important. Having a friends
circle, learning, sharing and playing is vital.

b) In what manner do you see yourself participating in the nurturing of the above?
We believe that parents role model behaviours for their children to pick up. As parents, we will work
proactively to create an environment for Samanth to explore possibilities in academics, arts, sports and
social life. We would like to enable opportunities for him to explore nature and interact with people who
don't have the privilege that he does. In this way, he will understand what he has and what he is capable
of offering.
c) What would you not like your child to learn through schooling?
No to the rat race. No to unmindful living. No to bullying and exclusion. No to wastage. No to brash and
insensitive behaviours. No to disrespect for fellow beings. No to binaries of success vs. failure. No to a
singular learning approach. No to inaction.

d) What according to you is education?

Education is enabling growth. Physical, mental, emotional, spiritual and environmental. Education is
appreciation - of what we have to offer, of our privilege and of our position and knowing that WE is
more important than I. Education is awareness - to the self and to the world around you. Education is
rigour - Nothing comes without working for it. Education should be joy - Students have to enjoy the
learning process and not just learn to pass exams and score marks. Education is insight - the ability to
gain insights into how you want to grow and what you want to do. Education is everyday - School and
home coexist in making and shaping the child. Education is sharing - Perspectives enable us to see the
world in its many dimensions. Education is compassion.

e) A description of the child

1. Temperament and personality:

Smiling, cheerful and jumpy. He's an explorer when he's learning new things. He naturally gravitates
towards numbers, logic and patterns. He takes his time to form friends and forms deep relationships.
He's expressive in his own way when sharing his thoughts with you.
2. Aptitudes and interests:
Samanth enjoys learning and doing new things, whether language, numbers or craft. His current
favourites are trucks and dinosaurs. He loves open spaces and enjoys his play time. He loves open
spaces and explores natures (He picks up bugs with his hands while learning about them)
3. Academic profile (Not applicable for Playgroup to Class 2)

School is a like a second home and a space of learning.

f) Please comment on the following: Education is enablement of a holistic development of
the child and academics being one dimension. With the
right aptitude that the school can enable, the child can
1. Academics and school education: learn to navigate life and if he is academically inclined,
we nurture that quality.
 2. Demands of parenting today:
Parents have the opportunity to learn and engage with their children, be present and support their growth. The
challenge comes in balancing the demands of work and home or possible comparisons and benchmarks for your
child that may be decided externally. For us, we would like Sam to be the best version of himself and we will put in
our best efforts to enable this for him

3. What are the three important influences that you foresee as acting on your
child in the next five years in order of importance? (No.1 being most
important)
1. Home
2. Home & Prakriya
3. Friends and social circle
These are the three influences. Home provides the foundation, while the rest are key influencers for his growth and
development.
4. What are your views on introducing technology to young children?
Samanth was kept away from technology until the age of 3.5 years. In the last 1.5 years, owing to the pandemic,
we have seen how online schooling and technology has helped, in explaining and understanding concepts of
space, dinosaurs, vehicles and other learning. Introducing technology where relevant can be useful. Being glued
to your screens is definitely counter productive. Controlled technology to children above the age of 5 can have its
merits
g) What are your reasons for choosing Prakriya for your child's education?
We want an environment that would enable compassion and inspire a connect with nature and creativity. We want
Samanth to work with a sense of curiosity and possibilities. We talked to parents in Prakriya who have been
happy with the school's methodology. The environment looks open and connected to nature. We heard about how
teachers engage with students as well as the student: teacher ratio. We like the blended approach to learning,
with materials and textures (Newspapers/spoons to learn concepts). We would really like Samanth to be part of
Prakriya.
h) How do you spend time with your child?
When Samanth was 2.5 years, we made him sit on the kitchen top, taught him to break eggs and pour his own
omlette. We run a lot, we play a lot. From imaginary dinosaurs to pillow fights, we do all things fun. We read out a
lot to him and he's slowly beginning to read as well. We play board games together. We ride on a balance scooter
around the community we live in. He loves solving puzzles and mazes. He loves working with paint and colour
and is already making abstract work. And we are involved and work with him on his everyday learning.

i) How do you spend time during weekends and holidays?

Some weekend road trips when possible. Meeting friends and family in Bangalore, some art and craft activities,
some movie watching, sports watching with pop corn and mostly chilling without an agenda. just be!

G. Interests:
a) Mother: Theatre, storytelling & performing arts. Interested in photography, film making
Passionate about Climate Change and gender equality. Considers herself a chef
Cycling enthusiast, poet and visual artist

b) Father: History and Culture. Sports Fanatic and interested in Social Impact & development
Passionate about Fitness and team sports
Avid traveler and loves meeting new people and engaging in conversations
I / We hereby certify that the information given in this application form is correct to the best
of my knowledge and that no information has been withheld or not disclosed/ disclosed
partially. (If any non-disclosure or partial disclosure of information or incorrect information is
given in the application form, the school reserves the right to cancel admission given to the
child).

I/ We agree to abide by the rules and regulations and any amendments thereof, formulated
by Prakriya Green Wisdom School.
Name & Signature of the mother / guardian:

Name & Signature of the father / guardian:

Date:

Place:

Documents enclosed with the application (Please tick where applicable):

(1) Copy of the Birth certificate of the child
(2) Copy of transfer certificate issued by the School last attended (if applicable)
(3) Copy of Aadhaar card
(4) Copy of the latest Transcript / Report issued by the school last attended / attending
(5) 1 passport size photo of the child, father and mother.
(6) Medical Reports and Recommendations (if any)
(7) Professional assessment reports of L.D (if applicable)