INDIA SUDAR EDUCATIONAL AND CHARITABLE TRUST Registered No: 454/2004 web: www.indiasudar.org mail: admin@indiasudar.

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Institution Information Survey Form Institute & Students Particulars

1. Type of the institution (Please tick the appropriate ) Government school ( Homes/orphanages ( Primary Government middle Private) high Hr.Sec)

Specify if others________________________________________________________________ 2. Institute Address:

Pin code : Phone no: 3. Name of the Contact person (Headmaster/warden/coordinator): Phone No: 4. E-mail ID (if any): 5. How do you know about India Sudar?

6. Students Information Classes 1st 2nd 3rd 4th 5th 6th Boys Girls Total Classes 7th 8th 9th 10th 11th 12th College students (for homes only) Total Strength Boys Girls Total

For office use only: Requested Organization: Name of the Indiasudar Work Coordinator with Member code:

Date:

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Institute background (Fill whichever applicable)

7. Year of establishment: 9. No of teachers: 11. Last year performance Class SSLC +2 12. Need more teachers?
requirement If yes, provide the reason and

8. No. of class rooms: 10. No. of clerks/helpers/peons: First mark Averag e mark

Pass %

Reason for the performance

19. Average Income of families of students

13. Is dropout rate high? If yes, Provide the reason

20. Economical status of parents of majority of students

14. Do you need any help to improve the students performance?

21. Educational status of parents of majority of students

15. Any other NGO supporting this school?

provide details

If yes

22. List of villages from where students attend schooling here

16. Support/help from Parents Teachers Association (PTA) and local bodies? Give the details.

23. Are students attending any coaching classes outside??

17. Population of near-by villages

24. Any Tuition centers available?

18. Primary occupation of the parents of majority of students

25. Additional information if any:

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Requirements (Give the details only for the basic needs and items which are most
important.) Requirement Particulars with explanation

26. Stationery (for students only)

27. Uniform for students

28. Computers

29. CD/DVD (spoken English/science/general)

30. Teaching models

31. Sports goods

32. TV , Radio

33. Newspapers and magazines

34. Library Facility

35. Environment related needs (Plants, Axe, spade etc.)

36. Medical camp

37. Food (only for homes)

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38. Furniture

39. Drinking Water Facility

40. Toilet facilities for teachers

41. Toilet facilities for students

42. Building Requirement 43. Other requirement if any.

Note: 1. Decision will be taken based on the following parameters. a. Utilization of government funds and other schemes. b. Actual needs and priority of the requirement. 2. Final decision will be taken after the field visit to the institution and interaction with its head and staffs.

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