Child Education Program – New Admission Form (Remedial Education Program)Please fill this form correctly. Student Name Gender —Please choose an option—MaleFemaleTransgender Class that you want to take admission —Please choose an option—23456789101112 Mobile Date of Birth Name of the teacher —Please choose an option—KusumNasreenNeetu BhardwajRakhi GuptaUshaPooja DeviPriyankaShweta BhardwajNishaVaniMumtazSamikshaSoniaPreetiLaxmiPooja JainNeetuShahnazShahwazJay RamAfsanaJiyaulRavi Date of admission Name of the School —Please choose an option—MCD B1 JJ Colony BawanaMCD B2 JJ Colony BawanaMCD E3 JJ Colony BawanaMCD E4 JJ Colony BawanaMCD E5 JJ Colony BawanaMCD BawanaGGSSS No. 1 JJ Colony BawanaGGMS No. 2 JJ Colony BawanaGBSSS No. 2 JJ Colony BawanaRSSKV BawanaGBSSS Bawana Category —Please choose an option—GenOBCSCST Religion —Please choose an option—SikhismAtheistHinduismChristianityIslamBuddhismJewsZorastrianJainismOthersNot to be Disclosed Father’s Name/Guardian Name Father’s occupation —Please choose an option—Govt. JobPrivate CompanyWorks in ShopWorks in FactoryBangle/Bindi MakerTutorCommission AgentGuard/WatchmanWashermanWorks in NGOBarberCobbistTailorDelivery manDriver-ownsDriver-rentedTypistElectricianPriest/AstrologerMilkmanPotterScrap dealerEarns from singing & DancingEarns from local PerformancesStreet HawkersNot Applicable Mothers Name Mother’s Occupation —Please choose an option—Govt. JobPrivate CompanyWorks in ShopWorks in FactoryBangle/Bindi MakerBeautician/MakeupTutorCommission AgentGuard/WatchmanWashermanWorks in NGOBarberCobbistTailorDelivery manDriver-ownsDriver-rentedTypistElectricianPriest/AstrologerMilkmanPotterScrap dealerEarns from singing & DancingEarns from local PerformancesStreet HawkersNot Applicable Father’s Income —Please choose an option—Less than 60,00060,000 – 1,20,0001,20,000 – 2,40,0002,40,000 and aboveNot applicable Family Income (Mother or Brother) —Please choose an option—Less than 60,00060,000 – 1,20,0001,20,000 – 2,40,0002,40,000 and aboveNot applicable Block —Please choose an option—ABCDEFGHIJKLMNOPQRSTUVWXYZNA House no. Type of Accommodation —Please choose an option—OwnRented Locality —Please choose an option—J J Colony BawanaNA Number of Brother’s Number of Sister’s Health Status FitNot Fit Repetition of class —Please choose an option—NA123456789101112 If personal Disability —Please choose an option—Speech & Hearing ImpairmentLow VisionLocomotor ImpairmentVisual ImpairmentDifferently abledNot applicable Whether Minority —Please choose an option—YesNo Below Poverty Line —Please choose an option—YesNo Possess of Ration No. Student’s Aadhar Number Period of Stay —Please choose an option—Less than 2 Years2 Years to 5 YearsMore than 5 Years Educational Qualification of Father —Please choose an option—IlliterateNon Formal Education\Less than 5th ClassPrimary (5th Pass)Middle (8th Pass)10th Pass12th PassGraduationPost Graduation Educational Qualification of Mother —Please choose an option—IlliterateNon Formal Education\Less than 5th ClassPrimary (5th Pass)Middle (8th Pass)10th Pass12th PassGraduationPost Graduation Employment Status of Father —Please choose an option—Self-employed at homeSelf-employed/shop/office/but not at homeWage employed workshop/ Office but not at someone homeGovernment Department/Shop/OfficeUnemployedNOT APPLICABLE Employment Status of Mother —Please choose an option—Self-employed at homeSelf-employed/shop/office/but not at homeWage employed workshop/ Office but not at someone homeGovernment Department/Shop/OfficeUnemployedNOT APPLICABLE Email Δ
