Application Form Application No.

Year 2018-19

Child Information

Full Name ______________________________________________________

Date of Birth ______________________________________________________

Aadhaar ID _____________________________________________________ Paste Photo Here

Gender Male Female

Mother’s Information

Mother Name _________________________________________________________________

Aadhaar ID _______________________________ PAN No __________________________

Occupation _________________________________ Education ____________________________

Father’s Information

Father Name _____________________________________________________________________

Aadhaar ID _______________________________ PAN No __________________________

Occupation _________________________________ Education ____________________________

Guardian's Information

Guardian Name ________________________________________________________________

Aadhaar ID _______________________________ PAN No __________________________

Occupation _________________________________ Education ____________________________

Bank Account Information

Child Bank Information

Child A/c No ___________________________________IFSC Code ____________________________

Bank Name_________________________________________Branch Name___________________________

Account Holder Name________________________________

Parent Bank Information

Parent/Guardian A/c No__________________________ IFSC Code __________________________

Account Holder Name_____________________________Aadhaar No Linked to Account_______________

Bank Name_________________________________________Branch Name___________________________

Annual Income _________________________

Contact Information

Mobile No ___________________________2nd Mobile No _______________________________________

Parent’s Email Address ____________________________________________________________________

Address

House No. ______________________________ Society ____________________________________

Locality_________________________________ Landmark ______________________________________

District _________________________________ Taluka_________________________________________

Village __________________________________ Ward______________________________________________

PIN Code _________________________________

Admission Information
Admission Class _________ Medium Option (1) __________________ Medium Option (2)_________________
Category Of Application

1. Orphan

2. Child In Need or Care and Protection

3. Children belonging to Child care Institution

4. Child Labour / Children belonging to migrating laborers

5. Mentally Challenged/ Child Cerebral Palsy/CWSN

6. HIV Infected Children

7. Children of Martyr soldier

8. BPL children of given category (SC,ST,SEBC and General) with points 0 to 20

SC ST SEBC/OBC General

9. SC/ST

SC ST

10. 1 SEBC/OBC

11. 1 General Category

For SC, ST,SEBC and General Category

Is Urban/ Rural? Urban Rural

For SEBC/OBC Category

Are you a Nomadic and De-notified Tribes (NDNT)? Yes No

School Selection

Sr No School Name Board Medium Std Distance

(Km)
1
2
3

4
5
6
7
8
9

10

Required Documents

Sr No Document

5
Application has to be submitted to nearby Receiving Center.

_______________________ _____________________________

Date Mother/Father/Guardian’s Signature

--------------------------------------------------------

Receipt

Received from__________________________for RTE 2018-19 Application No __________________

_____________ _________________________ ___________________________________

Date Receiving Center Name Sign and stamp of person receiving application

Note: If you (Parent) are not able to fill online application form then print this form, fill all details

and submit to receiving center. Take Receipt from receiving center. Thereafter receiving center

personnel submit the form online and provide an Application form no. Application form no will be

required for entire process of admission.