School Management Software - SAMPOORNA Data Collection Format

School Code

Name of School : .............................................................................................. Std. & Div: ....................... I. Personal Details

Admission No:.................

Name of Student (in English) : (in Malayalam) : ................................................................................................................ Gender

Male

Female

Nationality : .......................................

II. Parent Details Name of Mother (in English) : ................................................ (in Malayalam) :................................. Name of Father (in English) : ................................................. (in Malayalam) :................................. Guardian : Father

Mother

Other

If ‘Other’ (specify Relation) :........................................ Name of Guardian : ................................... Occupation of Parent/Guardian: ........................................ Annual Income (Rs) :.......................... Whether APL

BPL

III. Address Details House Name

:.............................................................

Place/Street :....................................

State

:.............................................................

Revenue Dist.:...................................

Taluk

:.............................................................

Whether Grama Panchayath

Municipality

Corporation

If Grama Panchayath (Specify) District Panchayath :.................................................... Block Panchayath :....................................... Name of Local Body :............................................................................ Post Office :......................................................... Phone Number :................................................

Pin Code :.......................................... Student E-mail ID :.........................................

IV. Previous School Details T.C No.

:........................................

Date :.........................................

Date of Admission:........................................

Date of Leaving : .........................................

School Previously Attended :.................................................................................................................. V. Admission Details Date of Admission :..................................

Date of Birth :....................................

Place of Birth :..........................................

Blood group :....................................

Religion

Hindu

Christian

Muslim

Islam

Jain

Sikh

Buddhist

Bahai

Secular

Judaism

OBC

OEC

Non-Religion Category : General

Not Applicable SC

Caste :...........................................................

ST

VI. Class of Admission Std. on Admission :...................................................

Division on Admission :.................................

VII. Current Details Class

:...............................................

Whether CWSN

: No

If ‘Yes’ specify

: Blindness (40% or above disability)

Yes

Division :...................................................

(CWSN-Children With Special Needs)

Leprosy Cured

Hearing Impaired (40% or above disability)

Loco Motor Disability Autism

Low vision (20% - 39% or above disability)

MR

Cerebral Palsy

Mental illness Speech Impairment

If Learning Disability : LD (Dyslexic)

LD (Dysgraphia)

Instruction Medium : Malayalam

English

Tamil

Others

LD (Dyscalculia) Kannada

First Language Paper I : Malayalam

Addl Eng

Addl Hindi

Sanskrit (A)

Arabic

Urdu

Tamil

Kannada

Gujarati

Sanskrit (O)

First Language Paper II : Malayalam

Spl Eng

F Science

Spl Sanskrit

Arabic (O)

Urdu

Tamil

Kannada

Gujarati

Sanskrit (O)

Third Language : Genreal Knowledge

Hindi

VIII. Vaccination Details Vaccinated : Yes

No

Date of Vaccination :................................................

IX. Two Identification Marks (In English only) 1. .................................................................................................................................................................. 2. .................................................................................................................................................................. X. Clubs IT

Social

Economics

Science

NGC

Tourism

Maths club

Social club

Arts club

Career Club

Work experience

Gandhi Darshan

Forestry club

Green club

Eco club

Health club

Readers club

Energy club

Filately club

Social service

Sports club

NCC

Guide

Teen club

Film club

Vidhya Rangam kala sahithya vedi

Arabic club

Nature club

English club

Junior Red Cross

Signature of the Parent/Guardian

Hindi club

Name and Signature of the Class Teacher