GOVERNMENT OF NATIONAL CAPITAL TERRITORY OF DELHI
DIRECTORATE OF EDUCATION
IEDSS BRANCH, LAJPAT NAGAR
(COMMON FORM FOR APPLYING TO ADMISSION IN ENTRY LEVEL CLASS/ES BY SPECIALLY ABLED CHILDREN IN UNAIDED
RECOGNIZED PRIVATE SCHOOLS OF DELHI)
For Session :2018-19
Name of The Student:
DOB (dd/mm/yyyy)
AGE: (years/months/days)
Gender:
Class:
Mother's Name:      
Father's Name:     
Guardian's Name: 
Residential Address:
Contact Numbers:  
Father--               
Mother--           
Residence--



Family Doctor Details:(Optional)  
Name--                                        
Contact Number-- 


(a)Whether school transport needed
(b)Whether the parents/guardians shall make their own arrangements of transportation to the school/back home
(i)Case History,if any
(ii)Whether recommended any assistive devices by the Medical Experts
(iii)Whether undergoing any therapeutic treatment on date
(iv)Whether recommended any attendant assistance by the attending physician
(In case of Hostel facility,Aayah Assistance)
DISABILITY INFORMATION
Select Disability