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Application for Student Enrolment

Course Application / Admission Form

Name of Applicant
Gender
MaleFemale
Date of Birth
Monthly Income of Applicant (Pension etc,)
Marital Status of Student
MarriedSingleSeperated
Date of Blindness
Have you been under treatment for any ailment in the past?
if the answer is 'Yes' state the details of ailment and the treatment
Date of Onset
Date of Recovery
Other physical or mental disability, if any
How do you spend your Leisure time?
Can you travel, move independently? What are the aids used? White cane etc?
Range of travel/movement?
Indoors
Outdoors
Select if you have a discount Travel Certificate for
BusTrain

Previous Education

Name of School
Date of joining
Date of leaving
Exam passed
Any vocational training?
What are your goals and aspirations?

Family Details

Father's/Guardian's Name
Relationship to Student
Father/Guardian's Address
Contact No.
Profession of Parent/Guardian
Monthly Income of Parent/Guardian
No. of brothers & sisters
List from oldest to youngest

Additional Documentation

You can upload scanned copies of the following documents, or provide xerox copies to us at a later date.
Blindness Certificate
Educational Certificate
Passport Sized Photograph

Verification

Please enter any two digits *Example: 12
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If you would like to print a copy, you can download a copy of this form as a PDF.