SSEPD::Social Security & Empowerment of Persons With Disabilities Department

SPECIAL SCHOOL ADMISSION FORM

District

Special School Name

Admission into which Class

Day Care Residential

Mode Of Transport

Child Name

Parent's Name Guardian Name

Disability Type

Disability Percentage

Photo

Upload Image (.JPG/.JPEG Format is Allowed)

Gender

Aadhar No. of Student

Parent/Guardian MobileNo

Social Category(Caste)

DOB

AGE

Mother Tongue

Medical History of The Child

State

District

Sub-division

Address Type

Block

Village

House No/Plot No

Account Holder Name

Account Number

IFSC Code

Bank Name

Upload Aadhar Scan Copy

Upload Age Proof

UDID / Identity Card

Caste Certificate

Transfer Certificate

Medical Case Record

Signature of Parent/Guardian

Additional Document

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