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STUDENT INFORMATION

Name of the Student*

Date of Birth*

Gender*
MaleFemale

Age

Entry Class*

Identification Marks

Caste

Subcaste

ADDRESS INFORMATION

Nationality

Phone*(Home)

Address (Home)

Pincode

PARENTS INFORMATION

Father Name

Father Age

Father Qualification

Father Occupation

Address (Office)

Phone (Office)

Mobile*

E-Mail

Mother’s Name

Mother’s Qualification

Mother’s Age

Mother’s Occupation

Adderess (Office)

Phone (Office)

Mobile*

Name of the Brothers/Sisters

Name

Birth Date

Class

School

Other Info

Languages Spoken at Home

Proficiency of English

Writing

ModerateFluent

Speaking

ModerateFluent

Reading

ModerateFluent

Previous Education

Name of the Education

Period of Study

Class

Reason for Change

Achievements in co-curricular activities

If you child ever received any learning support, please indicate the areas below

Speech and Language

Reading And Writing

Mathematics

Social Skills

Motor Skills

(e.g.. Hand Writing or Physical Education)

Are you aware of any learning support that your child will need ?

What are the long-term goals for your child ?

What Type of Environment do you think is required for your child to full fill his/her potential ?

As a parent, what role do you play in your child’s Education ?

Two areas which you would like to participate in

Counselling

YesNoMaybe

Guest Lecture in your area of Expertise

YesNoMaybe

Field Trips

YesNoMaybe

Science fares

YesNoMaybe

Educational Tours

YesNoMaybe

Contact Us

SRIKAKULAM – 9666711193, 9642220380

SRIKAKULAM PRIMARY – 8333897375

S.KOTA – 9505518599, 8519827027

KOTHAVALASA – 9603366975, 9063452795

kaumudischools@gmail.com

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