ek fo|kFkhZ dk uke

ekrk dk uke
firk@vfHkHkkod dk
tUe frfFk fo|ky; esa izos'k
cLrh@LFkkuh; ;fn vk/kkj
da Name of Student
Mothers Name
uke
{ks=@okMZ ;wvkbZMh uEcj fnukad/ ekg/o"kZ
dh frfFk
S.No
Fathers/
Habitation miyC/k gks Hkjsa Date of Birth fnukad/ ekg/o"kZ
Guardians Name

1
2
Name (Rural) Aadhaar
or
UID No.:
(If available)
Locality
(Urban)

3
4
5

DD/MM/YY
DD/MM/YY

fnu
ekg
o"kZ

fnu
ekg
o"kZ

8
9
10
11
12
13
14
15
16
17
18

xr o"kZ (2011-12) cPpksa dks iznku dh xbZ lqfo/kk,W (To be

filled by Government/ Aided schools only)

19
20
21
22
23
24

\ Whether the child is homeless

fu%'kqYd ifjj{k.k lqfo/kk \ Free escort facility

ykxw ugha&0@gkWa&1@ugha&2
fu%'kqYd Nk=kokl lqfo/kk * \ Free hostel facility
ykxww ugha&0.KGBV=1, Non KGBV=2,Other=3*
D;k cPps us fo'ks"k izf'k{k.k izkIr fd;k gS \ ykxw
ugha&0@vkoklh;&1@xSj vkoklh;&2
D;k fo|kFkhZ x`gfoghu~ gS\* ykxww ugha&0

fu%'kqYd okgu lqfo/kk \ Free transport facility

ykxw ugha&0@gkWa&1@ugha&2

eqr onhZ ds lsV \ No. of uniform sets provided

dqN ugha&0@,d lsV&1@nks lsV&2@ykxw ugha&99

fu%'kqYd ikB~; iqLrdksa dk lsV @ Complete set of

free Text Books ykxw ugha&0@gkWa&1@ugha&2

D;k cPpk izkbosV Ldwy esa gfj;k.kk f'k{kk fu;ekoyh 2003 dh

/kkjk 134-A ds rgr fu%'kqYd f'k{kk izkIr dj jgk gS \ykxw
ugha&0@gkWa&1@ugha&2
xr o"kZ (2011-12) esa fu%'kDr cPpksa dh iznku dh xbZ
lqfo/kk,W * \ Facilities provided to CWSN *

fu%'kDr~rk ;fn gks rks * \ Disability, if any *

Urdu =18, English =19 )

f'k{k.k dk ek/;e \ Medium of instruction (Hindi = 04,

No. of days child attended school in previous year

cPpk xr o"kZ Ldwy esa dqy fdrusa fnu mifLFkfr jgk gS \

Studying in classI, status of previous year *

;fn d{kk 1 esa i< jgk gS rks xr o"kZ dh fLFkfr crk;s a\ If

year (1,2,3,4,5,6,7,8, 0-Pre primary , None=99)

fiNys o"kZ v/;ujr~ d{kk \ Class studied previous

Pre Primary)

v/;ujr~ d{kk / Studying in class (1,2,3,4,5,6,7,8 ,0-

D;k oafpr lewg

(ykxw ugha&0@gkWa&1@ugha&2

BPL (Yes =1, No=2)

ls gSa * \ Disadvantaged Group *

D;k chih,y ds varxZr vkrs gSa \ Whether belong to

ckS)&5] tSu&6] vU;&7

/keZ \ Religion* fgUnw&1] eqfLye&2] blkbZ&3] flD[k&4]

tkfr \ Social category* Gen.=1, SC=2, ST=3,BC=4

fyax ckyd &1@ckfydk &2 \ Gender (Boy=1/Girl=2)

Date of
Admission

izos'k ekad \ Admission Number

fo|ky; dk Mkbl dksM /U-DISE School Code:

Aadhaar Friendly DISE 2012 -13 Students Profile

School Name: _____________________ ____ Village Name/ Locality (Urban) ________________________ Block Name ____________ Sheet No. ____Of_____ (Total)

25
26
27
28

(10) lkekftd oxZ% lkekU;&1] vuqlwfpr tkfr&2] vuqlwfpr tutkfr&3] vU; fiNM+k oxZ&4 \Soci al
cat egor y: Gener al =1, SC=2, ST=3, OBC=4
(11) /keZ % fgUnw&1] eqfLye&2] blkbZ&3] flD[k&4] ckS)&5] tSu&6] vU;&7 \ Religion: Hindu=1,
Muslim=2, Christian=3, Sikh=4, Buddhist=5, Jain=6, Others=7
(13) oafpr lewg ls gSa \ Disadvantaged Group : HIV ls ihfM+r vfHkHkkod dk cPpk , vukFk cPpk, ;q} esa
kghn gq, vfHkHkkod dk cPpk o CWSN cPpk gS rks ;s cPps oafpr lewg ls gSa A
(16) Status fo previous year: cPpk mlh Ldwy dh iwoZ izkFkfed esa i<+ jgk Fkk & 1, cPpk nwljs Ldwy dh iwoZ
izkFkfed esa i<+ jgk Fkk &2 , cPpk vkaxuokMh dsUnz esa i<+ jgk Fkk &3 o ;fn cPpk ?kj ls lh/kk Ldwy vk;k gS rks dksM & 4

fo|ky; fodkl lfefr ds v/;{k ds gLrk{kj \Signature of SMC President _______________

fnu

ekg

o"kZ

fnu

ekg

o"kZ

11

12

13

14

15

16

17

D;k cPpk izkbosV Ldwy esa gfj;k.kk f'k{kk fu;ekoyh 2003 dh

/kkjk 134-A ds rgr fu%'kqYd f'k{kk izkIr dj jgk gS \ykxw
ugha&0@gkWa&1@ugha&2
xr o"kZ (2011-12) esa fu%'kDr cPpksa dh iznku dh xbZ
lqfo/kk,W * \ Facilities provided to CWSN *

19

20

21

22

23

24

25

\ Whether the child is homeless

fu%'kqYd Nk=kokl lqfo/kk * \ Free hostel facility

ykxww ugha&0.KGBV=1, Non KGBV=2,Other=3*
D;k cPps us fo'ks "k izf'k{k.k izkIr fd;k gS \ ykxw
ugha&0@vkoklh;&1@xSj vkoklh;&2
D;k fo|kFkhZ x`gfoghu~ gS\* ykxww ugha&0

fu%'kqYd ifjj{k.k lqfo/kk \ Free escort facility ykxw

ugha&0@gkWa&1@ugha&2

fu%'kqYd okgu lqfo/kk \ Free transport facility

ykxw ugha&0@gkWa&1@ugha&2

eqr onhZ ds lsV \ No. of uniform sets provided

dqN ugha&0@,d lsV&1@nks lsV&2@ykxw ugha&99

fu%'kqYd ikB~; iqLrdksa dk lsV @ Complete set of

free Text Books ykxw ugha&0@gkWa&1@ugha&2

Urdu =18, English =19 )

18

filled by Government/ Aided schools only)

fu%'kDr~rk ;fn gks rks * \ Disability, if any *

f'k{k.k dk ek/;e \ Medium of instruction (Hindi = 04,

No. of days child attended school in previous year

cPpk xr o"kZ Ldwy esa dqy fdrusa fnu mifLFkfr jgk gS \

Studying in classI, status of previous year *

10

;fn d{kk 1 esa i< jgk gS rks xr o"kZ dh fLFkfr crk;s a\ If

Pre Primary)

year (1,2,3,4,5,6,7,8, 0-Pre primary , None=99)

fiNys o"kZ v/;ujr~ d{kk \ Class studied previous

BPL (Yes =1, No=2)

DD/MM/YY

(If available)

D;k oafpr lewg ls gSa * \ Disadvantaged Group*

(ykxw ugha&0@gkWa&1@ugha&2
v/;ujr~ d{kk / Studying in class (1,2,3,4,5,6,7,8 ,0-

Date of
Admission

D;k chih,y ds varxZr vkrs gSa \ Whether belong to

DD/MM/YY

tSu&6] vU;&7

Aadhaar
UID No.:

/keZ \ Religion* fgUnw&1] eqfLye&2] blkbZ&3] flD[k&4] ckS)&5]

Name
(Rural)
or
Locality
(Urban)

tkfr \ Social category* Gen.=1, SC=2, ST=3,BC=4

tUe frfFk fo|ky; esa izos'k

cLrh@LFkkuh; ;fn vk/kkj
{ks=@okMZ ;wvkbZMh uEcj fnukad/ ekg/o"kZ
dh frfFk
Habitation miyC/k gks Hkjsa Date of Birth fnukad/ ekg/o"kZ

fyax ckyd &1@ckfydk &2 \ Gender (Boy=1/Girl=2)

Fathers/
Guardians Name

S.No

ekrk dk uke

Mothers Name

izos'k ekad \ Admission Number

ek
fo|kFkhZ dk uke
firk@vfHkHkkod dk
da Name of Student
uke

xr o"kZ (2011-12) cPpksa dks iznku dh xbZ lqfo/kk,W (To be

26

27

28

(19) fosdykaxrk ugh&0]n`f"Vghu~&1] vkaf'kd n`f"Vghu&2] Ekwd cf/kj ~&3] ok.kh nks"k~&4] vfLFkckf/kr~&5] ekufld fodykax&6] vf/kxe fodykax &7] lsjsczy ikYlh&8] vkfVTe&9] cgq fosdykax&10 \ Disability:
NA=0, Blindness=1, Low vision =2, Hearing impaired=3, Speech impairment=4, Loco motor=5, Mental Retardation=6, Learning di sability= 7,
Cerebral Palsy=8, Autism=9, Multiple Disabili ty=10,
(21) ;fn cPpk lkekU; gS rks ykxw ugha&0] czsyfyfi dh iqLrdsa &1] czsy fdV&2] vYi n`f"V laca /kh fdV &3] Jo.k ;a= &4] czslsl&5] cSlk[kh &6] Oghy ps;j &7]VkbZ lkbZfdy&8] dSyhij&9] vU;&10 \ Facilities
provided to CWSN : Not Applicable =0, Braille books=1, Braille kit=2, Low vision kit=3, Hearing aid=4, Braces =5, Crutches=6, Wheel chair=7, Tricycle=8, Calliper=9, Others=10
(26) fu%'kqYd Nk=kokl lqfo/kk% ykxw ugha&0] KGBV &1] KGBV dks NksMdj vU; fu%'kqYd jktfd; Nk=kokl &2] vU; fu%kqYd Nk=kokl lqfo/kk &3 \ Free hostel facility : NA=0,
KGBV=1, Non KGBV (Government) Hostle =2, Others=3
(28) D;k cPpk x`gfoghu gS \ ykxw ugha&0] ekrkfirk@vfHkHkkod ds lkFk&1] fdlh dh lqj{kk ds fcuk vdsyk jgrk gS&2 \ Whether the child is homeless: NA=0, With Parents=1,
Without adult protection=2

eq[;k/;kid ds gLrk{kj \Signature of School Head _____________________ uke _____________________ ___

eksckby u0a -_____________________