PART B: STUDENT DETAILS-I

GENERAL INFORMATION OF STuDENT

Academie Year : 2022-23
UDISE Code of School: Student-1 Student-2 Student-3 Student-4 Student-5
Class:- SECTION
Roll no Roll no- Roll no: Roll no Roll no
(Mention A' if there are only 1

4.1.1 Name
Section)
of the Student (in Capital Letter):

4.1.2 Gender (Male-1, Female-2,

Transgender-3):
4.1.3 Date
of Birth (DD/ MM/ YYYY):
4.1.4 Mother's Name:
4.1.5 Father's Name

|4.1.6 Guardian's Name:

4.1.7 Aadhaar No of Child

4.1.8 Name of Student as Per/in Aadhaar:

4.1.9(a) Address:
4.1.9 (b) Pincode
4.1.10 (a) Mobile Number (ofStudent/ Parent/ Guardian)
4.1.10 (b) Alternate Mobile Number (ofStudent/ Parent/ Guardian):
4.1.11 Contact email-id (of Student/Parent/Guardian)
4.1.12 Mother Tongue of the Child:*
4.1.13 Social Category (SC-1, ST-2, OBC-3, General-4):
4.1.14 Minority Group
(Muslim-1, Christian-2, Sikh-3, Buddhist-4, Parsi-5, Jain-6, NA-7
4.1.15 Whether BPL beneficiary? (Yes-1, No-2)
If1-Yes, then (a) Whether Antyodaya Anna Yojana (AAY) beneficiary?
(Yes-1, No-2):_
4.1.16 **Whether belongs to EWS /Disadvantaged Group? (Yes-1, No-2)

4.1.17 Whether CWSN? (Ves-1, No-2):

IfYes,(a) Type ofimpaiment (code)**
4.1.12 (Mother Tongue ofthe Child:1-Assamese, 3-Bengali, 4-Chakma, 5-Hajong, 6-Rajbangs, 8-Bodo,9-Kachari, 28-Bhojpuri, 78-Kannada, 83-Kashmiti, 88-Konkani, 93-Maithili, 98-Malayalam, 102-Manipuri, 111-Bhuiy
112-Bhumijali, 114-0dia, 122-Punjabi, 132-Sindhi, 137-Tamil, 140-Telugu, 144-Urdu, 146-Adi, 147-Gallo, 148-Miniyong,185-8hotia, 186-Bhumij, 189-Manipuri, 190-Bishnupriya, I197-Deori, 198-Dinmasa, 200-English,
204-Garo, 224-Karbi-Mikir, 231-Khasi, 263-Kuki, 279-Limbu, 292-Miri-Mishing, 293-Mishmi, 297-Monpa, 304-4patani, 305-Nyshi, 306-Tagin, 308-Nocte, 320-Rai, 328-Sherpa, 331-Tamang, 332-Tangkul, 334-Tutcha Tangsa,
343-Tripuri, 348-Wancho, 999-0thers

4.1.17 (a) (Type of Impairment): 1-Blindness, 2-Lo-Vision, 3-Hearing impairment, 4-Speech and Language, S Locomoor Disability, 6-Mental illness, 7-5pecific Learning Disabitities, 8-Cerebral palsy, 9-Autism Spectrun
pisorder, 10-Multiple Disabiliy incl. deaf, blindness, 11-Leprosy Cured students, 12-Dwarfism, 13-Intellectual Disability, 14-Muscular Dystrophy, 1S-Chronic Neurological conditions, 16-Mulriple Sclerosis, 17-Thalassem-ia

18-Haemophi-lia, 19-Sickle Cell disease, 20-4cid Attack victim, 21-Parkinso-n 's disease

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 PARTB:STUDENT DETAILS-I
Student5
Student-1 Student-2 Student-3 Student-4

Roll no Roll no Roll no Roll no- Roll no

4.1.18 Whether the Child is Indian
National? (Yes- No-2)
4.1.19 Is
this Child identified Out-of-School-Child?
as (Yes-1, No-2):If
yes, (a) when the child is mainstreamed?
(n current academic year-1, In earlier academic year-2)
4.2.1 Admission Number in School:

4.2.2 Admission Date (DID/ MM/ YYYYY) in Present Class:

4.2.3 Academic Stream opted by student (For Higher Secondary Classes

only): for Art-1, Science-2, Commerce-3, Vocational-4, Other Streams-5)
4.2.3 (a) Satus of student in Previous Academic Year of Schooling

(2021-22) (1-Studicd at Current/Same School, 2-Studied a

: Other
School, 3-Anganwadi/ ECCE Centre, 4-NoneNot Studying
4.2.4 (b) Grade/Class Studied in the Previous/ Last Academie Year 21-22
(Fil f Answer of 4.2.3 is Option I or 2)

4.2.5 Admitted/ Enrolled Under (Only for Pvt. Unaided):

with Disabilities
(0- None, 1-Section 12 of the RTE, 2-EWS, 3-Persons
(PwD),4-Disadvantaged Group, 5-0thers)
In the Previous class studied
-

whether appeared for examinations:

4.2.6 (a)
(-Appeared, 2- Not Appeared)
examination:
(b) In the previous class Examinations of the
studied- Result
4.2.6
in
Option in case of 7-Appeared with grace
(1-PromotedPassed, 2-PromotedPassed
3-Detained/Repeater/Not Passed, 4-PromotedPassed wihout
Examination)
in the previous class
4.2.6(c) Option in case 1-Appeared in Examinations
of
examination
studied % of overallmarks obtained in the
attended school (in the previous academic year):
No. of days child
4.2.7

EWS-Economically Weaker Sections.

Name of BRCCICRCC

Name o fPrincipal/HM & Signature )

(Seal
Date:
(Seal & Signature)

Daie
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