STUDENT’S PROFILE
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Student’s Name………………………………………….
Age: ……………………
Gender :…………….
Nationality:………………….
Religion…………………
Residence: Urban ☐ Semi Urban ☐ Rural ☐
Number of siblings and position
Eye sight: Normal ☐ Use spectacles ☐
Father’s Education: …………………………
Father’s Occupation: ………………………….
Father’s monthly income: ………………………
Mother’s Education…………………………….
Mother’s Occupation…………………………….
Mother’s monthly income…………………………
Family’s Income (monthly): Below 15000 ☐15-30,000 ☐ 30-60,000 and
above☐
 Residence type: Own house ☐ Rented ☐
 Academic profile:
Name of the Examination
Board/ University
Marks obtained
<40% 40- 50- >60%
50% 60%
Madhyamik/ Secondary
Higher Secondary
Under Graduation
Post Graduation
 Special area of interest……………………………………………….
 Winner in any non-academic area:…………………………………….
 Have any physical illness: Yes ☐ No
o If Yes; Major ☐ Minor ☐
o If Major then name of the illness disease: