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REAL TIME IDENTIFICATION & INFORMATION MANAGEMENT SYSTEM (RIIMS)

CACHAR, SILCHAR
(Student’s Registration Form)

To be filled in Block Letter

Class: ___________ Section: ________________ Roll No.: ___________

Contact No: _____________________________

1. Student’s Aadhar No. (Optional) ___________________________________________________

2. Name of the Student: ____________________________________________________________

3. Father’s Name: _________________________________________________________________

4. Mother’s Name: ________________________________________________________________

5. District: ________________________________________________

6. Block: _________________________________________________

7. Cluster: ________________________________________________

8. Habitation/Lane: ________________________________________

9. Gram Panchayat (Ward No.) _______________________________

10. Date of Birth: ___________________________________________

11. Gender (Male/Female/Transgender) ________________________

12. Social Category (General/SC/ST(P)/ST(H)/OBC/MOBC) _________________________________

13. Sub Category (NA/Minority Muslim/Tea Tribe) _______________________________________

14. Religion: _______________________________________________

15. Mother Tongue/Home Language: ___________________________

16. Mode of E-Learning: ____________________________________________________________


Options: - (i) Smartphone with 4G Network (ii) Computer (iii) Laptop (iv) Smartphone
(v) 4G Internet Connection as well as TV with DTH/Cable Connection (vi) No access to Internet TV
Set/Cable Cable Connection (vii) No Digital Device.

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17. Date of Admission: ______________________________________

18. Admission No.: _________________________________________

19. Academic Year: _________________________________________

20. Studying in class in the year (2022 – 2023): _________________________________________

21. Stream (For Students of grades 11 & 12): ___________________________________________

22. Class Studied in the previous year (2021 – 2022): _____________________________________

23. No. of days child attended school (in prev. year) (Optional): ____________________________

24. Medium of Instruction: ___________________________________

25. Migration Type (NA/In Migration/Out Migration): ____________________________________

26. Last Examination Result (Promoter/Repeater/Discontinued/New Admission):______________

27. Last Examination - % of Marks obtained: _____________________

28. Student grade in the prev. class/year (A, B, C, D, E): ____________

29. Whether belong to Poverty Line – Yes/No (Optional) ___________

30. Disadvantage group (Optional) Yes/No: _____________________

31. Student’s Bank Details (Optional): __________________________

Signature of Parent/Guardian___________________________

Place: ________________

Date: ________________

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