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PEN Registration Form

The document outlines the general information, enrolment details, and facility profile of a student, including personal identification data, academic history, and family background. It covers aspects such as the student's name, gender, date of birth, addresses, contact information, social category, and educational details. Additionally, it addresses any special needs, disabilities, and the facilities provided to the student.

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smilingrimpy
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56 views3 pages

PEN Registration Form

The document outlines the general information, enrolment details, and facility profile of a student, including personal identification data, academic history, and family background. It covers aspects such as the student's name, gender, date of birth, addresses, contact information, social category, and educational details. Additionally, it addresses any special needs, disabilities, and the facilities provided to the student.

Uploaded by

smilingrimpy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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General Information of Student

1. Student's Name (as per School Record)

2. Gender

3. Date of Birth (DD/MM/YYYY)

4. Permanent Education Number NA

5. Mother's Name

6. Father's Name

7. Guardian's Name

8. AADHAAR Number of Student

9. Name of Student as per/in AADHAAR Card

10. Communication address

Pin code

Taluk name

District

11. Permanent address

with Pin code

Taluk name

District

12. Mobile Number (of Student/ Parent/ Guardian)

13. Alternate Mobile Number (of Student/ Parent/ Guardian)

14. Contact email-id (of Student/Parent/Guardian)

15. Mother Tongue of the Student

16. Social Category (SC/ST/OBC/GEN)

Whether belongs to Minority community YES / NO

17. If belongs to Minority Group Sikh/Jain/Muslim/Christian/Parsi/Buddhist

Whether chid have community certificate(Not for General)

18. Whether BPL beneficiary

19. Whether Antyodaya Anna Yojana (AAY) beneficiary

20. Whether belongs to EWS / Disadvantaged Group

21. Whether CWSN(Childrens with special needs)

22. Type of Impairments if any

23. Nationality

24. Is Child Identified as Out of School-Child(any drop out)

25. When the Child is mainstreamed

26. Whether having Disability Certificate


27. Disability Percentage (in %)

28. Blood Group

Enrolment Details of the Student


1. Admission Number in Present School

2. Admission Date (DD/ MM/ YYYY) in Present School

3. Class/Section Roll No

4. Medium of Instruction

5. Languages Group Studied by the Student

6. Academic Stream opted by student

7. Subjects Group Studied by the Student

8. Status of Student in Previous Academic Year Schooling (2023-24)

9. Grade/Class Studied in the Previous/Last Academic year (2023-24)

10. Admitted / Enrolled Under (Only for Pvt. Unaided) None

11. In the previous class Studied - result of the examinations Passed/Promoted

12. Marks Obtained (in Percentage)

13. No. of days child attended school (in the previous academic year)

Facility Profile
Whether Facilities provided to the Student (for the year of filling
1. NA
data)

Facilities provided to Student in case of CWSN (for the year of


2.
filling data)

Whether Student has been screened for Specific Learning


3.
Disability (SLD)

4. SLD Type

Whether Student has been screened for Autism Spectrum


5.
Disorder (ASD)?

Whether Student has been screened for Attention Deficit


6.
Hyperactive Disorder (ADHD)?

7. Has the Student been identified as a Gifted / Talented

Does the student appeared in any State Level Competitions/


8.
National level Competitions/ Olympiads?
9. Does the Student participate in NCC/ NSS/ Scouts and Guides?

Whether student is capable of handling digital devices including


10.
the internet?

11. Student's Height (in CMs)

12. Student's Weight (in KGs)

13. Approximate Distance of student's residence to school

Completed Highest Education Level of Mother/Father/Legal


14.
Guardian

15. Previous school address

16. Mother’s aadhar no:

Annual income

17. Mother’s qualification

18. Father’s aadhar no:

19. Father’s Qualification

20 Annual income

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