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SPECIAL SCHOOL ADMISSION FORM
School Related Details:
District
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ANGUL
BALESHWAR
BARGARH
BHADRAK
BOLANGIR
BOUDH
CUTTACK
DEOGARH
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHAPUR
JAJPUR
JHARSUGUDA
KALAHANDI
KANDHAMAL
KENDRAPARA
KENDUJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NABARANGAPUR
NAYAGARH
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SONEPUR
SUNDARGARH
Special School Name
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Admission into which Class
Day Care
Residential
Mode Of Transport
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School Bus Service
Own arrangement
Student Related Details:
Child Name
Parent's Name
Guardian Name
Guardian Name
Father's Name
Mother's Name
Disability Type
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Low Vision
Leprosy Cured Person
Locomotor Disability
Muscular Dystrophy
Acid Attack Victim
Dwarfism
Cerebral Palsy
Deaf
Speech & Language Disability
Hard of Hearing
Blindness
Mental Illness
Specific Learning Disability
Intellectual Disability
Autism Spectrum Disorder
Thalassemia
Sickle Cell Disease
Haemophilia
Parkinsons Disease
Multiple Sclerosis
Multiple Disability Including Deaf & Blindness
Chronic Neurological Conditions
No Disease
Others
Disability Percentage
Photo
Upload Image
Gender
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Male
Female
Other
Aadhar No. of Student
Aadhar No of Father
Aadhar No. of Mother
Aadhar No. of Guardian
Parent/Guardian MobileNo
Social Category(Caste)
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General
OBC
SC
ST
MINORITY
DOB
AGE
Mother Tongue
Medical History of The Child
Address :
State
District
-Select-
ANGUL
BALESHWAR
BARGARH
BHADRAK
BOLANGIR
BOUDH
CUTTACK
DEOGARH
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHAPUR
JAJPUR
JHARSUGUDA
KALAHANDI
KANDHAMAL
KENDRAPARA
KENDUJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NABARANGAPUR
NAYAGARH
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SONEPUR
SUNDARGARH
Sub-division
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Address Type
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ULB
Block
Block
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GP
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Village
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ULB Type
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Municipality
Municipal Corporation
Municipality
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City/Town
Ward No
House No/Plot No
PIN
Bank Account details of Parents/Guardian
Account Holder Name
Account Number
IFSC Code
Bank Name
Document :
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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