Aadhaar Friendly DISE 2012-13Students Profile

DISE School Code: School Name:……………………………………………………….. Sheet No…………………………. Of…………………………………... (Total)

Surname

Adm

issi

on N

umbe

r

Mot

her t

ongu

e*

Gen

der (

Boy=

1/G

irl=2

)

Soci

al c

ateg

ory*

Sub

Cast

e

Relig

ion*

Whe

ther

bel

ong

to B

PL (Y

es =

1, N

o=2)

Dis

adva

ntag

ed G

roup

(NA=

0, Y

es=1

, No=

2)

Stud

ying

in c

lass

(1,2

,3,4

,5,6

,7,8

,0-P

re P

rimar

y)

If St

udyi

ng in

cla

ss –

I, s

tatu

s of

pre

viou

s ye

ar*

No.

of d

ays

child

att

ende

d sc

hool

in p

revi

ous

year

Med

ium

of i

nstr

uctio

n *

Dis

abili

ty, i

f any

* (N

A=0)

MD

M ta

ken

or n

ot

Com

plet

e se

t of f

ree

Text

Boo

ks (N

A=0,

Yes=

1, N

o=2)

No.

of u

nifo

rm s

ets

prov

ided

(Non

e=0,

One

Set

=1, T

wo

Set=

2, N

A=99

)

Free

tran

spor

t fac

ility

(NA=

0, Y

es=1

, N

o=2)

Free

esc

ort f

acili

ty (N

A=0,

Yes

=1, N

o=2)

Free

hos

tel f

acili

ty *

(NA=

0)

Hos

tel I

nfor

mati

on

Whe

ther

the

child

is h

omel

ess

* (N

A=0)

Med

ical

che

ckup

(YES

/No)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

(10) Mother tongue: Telugu-1, Urdu-2, English-3, Tamil-4, Kanada-5, Marati-6, Oriya-7, Gujarathi-8, Others- 9.

(12) Social category: General=1, SC=2, ST=3, OBC=4

(14) Religion: Hindu=1, Muslim=2, Christian=3, Sikh=4, Buddhist=5, Jain=6, Others=7 (30) Free hostel facility : NA=0, KGBV=1, Non KGBV (Government)=2, Others=3

(19) Status of previous year : Same School=1, Another School=2, Anganwadi-ECCE=3, None=4

(21) Medium of instruction: Hindi = 04, Urdu =18, English =19, Others = 99 ( Will vary from state to state) (33) Whether the child is homeless: NA=0, With Parents=1, Without adult protection=2

Signature of SMC Chairperson Signature of Head Teacher

Name of the District :

Name of the mandal

Sl.No

Name of the Pupil

Father’s/ Guardian’s

NameMother’s

Name

Habitation Name

(Rural) or Locality (Urban) Address

Aadhaar UID No.: (If available)

Date of Birth DD/MM/YY

Date of Admission DD/MM/YY

Class in which

admitted

Clas

s st

udie

d pr

evio

us y

ear

(1,2

,3,4

,5,6

,7,8

,0-

Prep

rimar

y , N

one=

99)

Whe

ther

the

child

is g

etting

free

edu

catio

n in

priv

ate

unai

ded

scho

ol a

s pe

r RTE

Act

. (N

A=0,

Yes

=1 ,

No=

2)

Faci

lities

pro

vide

d to

CW

SN *

(Pre

viou

s ac

adem

ic y

ear)

Whe

ther

chi

ld a

tten

ded

Spec

ial T

rain

ing

(NA=

0, R

esid

entia

l=1,

Non

-Re

side

ntial

=2)

(22) Disability: NA=0, Visual (Blindness)=1, (Visual Low –vision)=2, Hearing impaired=3, Speech=4, Loco motor=5, Mental Retardation=6, Learning disability= 7, Cerebral Palsy=8, Autism=9, Multiple Disability=10,

(25) Facility CWSN : NA=0, Braille books=1, Braille kit=2, Low vision kit=3, Hearing aid=4, Braces =5, Crutches=6, Wheel chair=7, Tricycle=8, Calliper=9, Others=10

(31) Hostel Information: SC Boys Hostel-1, SC Girls hostel-2, ST Boys Hostel-3, ST Girls Hostel -4, BC Boys Hostel-5, BC Girls Hostel-6, Others-7.

Aadhaar Friendly DISE 2012-13Students Profile (main page)

Name of the District :

Name of the Mandal :

Name of the Village :

Name of the Habitation :

DISE School Code:

Name of the School

Category :

Management :

Medium 1

Medium 2

Medium 3

Medium 4

School located in Rural area or Urban Area

Name of the CRC

Assembly Constituency name

Name of the Parlament :

Aadhaar Friendly DISE 2012-13Students Profile Sheet No…… Of…... (Total)

District : Village : DISE School Code: School :

Sl.N

o

Student Studying Details Admin Details Parent/Guardian's Details

Aadh

aar U

ID N

o.: (

If av

aila

ble)

Surn

ame

Nam

e of

the

Pupi

l

Dat

a of

Birt

h

Gen

der *

Cast

e

Mot

her t

ongu

e *

Relig

ion

*

Dis

abili

ty, i

f any

* (N

A=0)

If St

udyi

ng in

cla

ss –

I, s

tatu

s of

pre

viou

s ye

ar*

Med

ium

of i

nstr

uctio

n *

Clas

s in

whi

ch a

dmitt

ed

Dat

e of

Adm

issi

on D

D/M

M/Y

YYY

Adm

issi

on N

umbe

r

Fath

er’s

/ G

uard

ian’

s N

ame

Mot

her’s

Nam

e

Whe

ther

bel

ong

to B

PL (Y

es =

1, N

o=2)

Dis

adva

ntag

ed G

roup

(NA=

0, Y

es=1

, No=

2)

Free

tran

spor

t fac

ility

(NA=

0, Y

es=1

, N

o=2)

Free

esc

ort f

acili

ty (N

A=0,

Yes

=1, N

o=2)

Free

hos

tel f

acili

ty *

(NA=

0)

Hos

tel I

nfor

mati

on *

Whe

ther

the

child

is h

omel

ess

* (N

A=0)

Med

ical

che

ckup

(YES

/No)

MD

M ta

ken

(Yes

=1,N

o=2)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

6). Boys=1,Girls=2

(7) Caste :General=1, SC=2, ST=3, OBC=4

(8) Mother tongue: Telugu-1, Urdu-2, English-3, Tamil-4, Kanada-5, Marati-6, Oriya-7, Gujarathi-8, Others-9.

(9) Religion: Hindu=1, Muslim=2, Christian=3, Sikh=4, Buddhist=5, Jain=6, Others=7 (30) Free hostel facility : NA=0, KGBV=1, Non KGBV (Government)=2, Others=3

(13) Status of previous year : Same School=1, Another School=2, Anganwadi-ECCE=3, None=4 (31) Hostel Information: SC Boys Hostel-1, SC Girls hostel-2, ST Boys Hostel-3, ST Girls Hostel -4, BC Boys Hostel-5, BC Girls Hostel-6, Others-7.

(15) Medium of instruction:Hindi =04,Kannada=05,Marathi=10,Oriya=12,Sanskrit=14,Telugu=17,Urdu -18, English -19, Others - 99 (33) Whether the child is homeless: NA=0, With Parents=1, Without adult protection=2

Signature of SMC Chairperson Signature of Head Teacher

Mandal :

facilities provided during previous academic year (to be filled by Govt.,/Aided Schools only)

Stud

ying

in c

lass

(1,2

,3,4

,5,6

,7,8

,9,1

0, 0

-Pre

Pr

imar

y)

Clas

s s

tudi

ed p

revi

ous

year

(1

,2,3

,4,5

,6,7

,8,9

,10,

0-Pr

eprim

ary

, Non

e=99

)

No.

of d

ays

child

att

ende

d sc

hool

in p

revi

ous

year

Hab

itatio

n N

ame

(Rur

al) o

r Loc

ality

(Urb

an)

Addr

ess

Whe

ther

the

child

is g

etting

free

edu

catio

n in

pr

ivat

e un

aide

d sc

hool

as

per R

TE A

ct. (

NA=

0,

Yes=

1 , N

o=2)

Faci

lities

pro

vide

d to

CW

SN *

(Pre

viou

s ac

adem

ic y

ear)

Com

plet

e se

t of f

ree

Text

Boo

ks (N

A=0,

Yes=

1,

No=

2)

No.

of u

nifo

rm s

ets

prov

ided

(Non

e=0,

One

Se

t=1,

Tw

o Se

t=2,

NA=

99)

Whe

ther

chi

ld a

tten

ded

Spec

ial T

rain

ing

(NA=

0,

Resi

denti

al=1

, Non

-Res

iden

tial=

2)

(10) Disability: NA=0, Visual (Blindness)=1, (Visual Low –vision)=2, Hearing impaired=3, Speech=4, Loco motor=5, Mental Retardation=6, Learning disability= 7, Cerebral Palsy=8, Autism=9, Multiple Disability=10,

(25) Facility CWSN : NA=0, Braille books=1, Braille kit=2, Low vision kit=3, Hearing aid=4, Braces =5, Crutches=6, Wheel chair=7, Tricycle=8, Calliper=9, Others=10

MEDINSTR_DESC04 - Hindi 04 - Hindi 05 - Kanna10 - Marat12 - Oriya 14 - Sanskr17 - Telugu05 - Kannada10 - Marathi12 - Oriya14 - Sanskrit17 - Telugu18 - Urdu19 - English99 - Others

18 - Urdu 19 - Englis 99 - Others