DEPARTMENT OF SCHOOL EDUCATION

STUDENT DATA CAPTURE FORMAT

1. 2. 3. 4. 5. 6. 7. 8. 9. School code Name of the Student D.O.B Gender Class Medium Group Code (For HSC Only) Nationality Religion U- dise code to be adopted DD/MM/YYYY Boy / Girl

10.

Community

INDIAN OTHERS HINDU MUSLIM CHRISTIAN OTHERS SC - Arunthathiyar SC - Others ST MBC BC Muslim BC Others OC Other Communities TAMIL/TELUGU/MALAYALAM/KANNADAM/OTHERS Govt. / Private / Agriculture / Self Employed / Daily wages Rs.

11. 12. 13. 14. 15. 16.

Sub Caste Mother Tongue (tick appropriate) Mother s Name Mothers Occupation (tick appropriate) Mothers monthly income Fathers Name

Fathers Occupation (tick appropriate) Fathers monthly income If differently abled type of disability (tick appropriate) 20. If belongs to disadvantaged group (tick appropriate) [Ref: G.O. Ms. No.180 Dt. 15.11.2011] 21. House address with pin-code 22. Native district 23. Student Id 24. Photo 25. Attendance Status 26. Sports participation 27. Contact Phone number 28. Blood Group 29. Brothers Details: S.No Name 1. 2. 3. 30. Sisters Details: S.No Name 1. 2. 3. 17. 18. 19.

Govt. / Private / Agriculture / Self Employed / Daily wages Rs. Ortho / Blind / Deaf Orphan / HIV Affected / Transgender / Child of a Scavenger

Will be auto generated Regularly present / Long Absent Block / District / Division / State / National Level

D.O.B

Qualification

Whether Employed (Yes / No)

D.O.B

Qualification

Whether Employed (Yes / No)

Signature of the Headmaster / Principal with seal

Signature of the Parent