4. & 5. Child Profile card and Approval Consent

 

Child Profile Card and Approval Consent

 

  1. Name: …………………………………………………………………….2. Surname: …………………………………………………
  2. Gender: q Male q Female                             4. Date of Birth: ……………………………………………………………….
  3. Name of Father: …………………………………………………… Name of Mother: ……………………………………………..
  4. Name of Guardian (if other than parent): ………………………………………………………………………………………….
  5. Child has previously studied up to which standard / class? : ……………… Age appropriate Class ……………….
  6. Street / Village: ………………………………………City / Block: ……………………..District: ……………………………….

State: ………………………………………………………Pin Code No. : ……………………………………………………………..

  1. Occupation of father / mother / guardian: ………………………………………………………………
11. Category (Please tick on the appropriate box)
SC      ST   OBC    Minority    General

q q q  q    q

   BPL                  APL

q    q

Physically Challenged

Yes  q     No  q

Approval Consent (to be filled at the time of screening)

[The entire exercise is being done to identify the right kind of children according to the below mentioned criteria. In Asha Kiran we will not support children who are already admitted and going to school regularly and have learning ability according to his/her age.]

Above mentioned child is under following marked criteria. (Please mark)

     The Child is between age group 7 to 14 years           Child has never been to school

Child is not attending school for more than 45 days without information to school

Child is a laggard ((e.g. the child’s age is 12 years but can read text of only Class II & III etc).

  • When did the child last go to school and in which class?

2 Days back q 45 Days back q Six months back q 1 Year Back q 2 year and above back q Never q

Class I q Class II q Class III q Class IV q Class V q Class VI q Class VII q

  • Please tick at the appropriate box about learning abilities of child at the time of screening and approval
  1. Letters Identification: Excellent qGood qModerate qPoorq 2. Reading: Excellent qGood qModerate qPoor q
  2. Spelling: Excellent qGood qModerate qPoor q 4. Basic Calculation: Excellent qGood qModerate qPoor q
  • If not going to school, then why?

His/her parents not send him/her qThe School very far from his/her house q Child is engaged with family earnings qOthers q If Others then Please specify……………………………………………………………………………………………………………….

The Child is agree to go back to school    Yes q    No q The Child is approved q disapproved q

 

  

Signature of Approval authority & Date                                                                      Signature of NGO representative & Date

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