Application form for free Hostel for the Blind - Thaaikarangal Charitable Trust

Thaaikarangal Charitable trust APPLICATION FORM FOR Free HOSTEL ACCOMMODATION For visually impaired Girls.

Student Name *

Father’s Name*

Mother’s Name *
Date of Birth*

Student Aadhar number

Student Disability ID number *
Mobile No of Student *

E-mail ID of Student *

Course Admitted *
Year in which studying *

Mobile No of Parent*

E-mail ID of Parent
Address of PARENT (in block letters) *
Name of the Local Guardian

Mobile No of Local Guardian
Address of the Local Guardian
Specify any health complaints of the STUDENT, if any
Student passport size photo:*
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(SIGNATURE OF THE STUDENT) *
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(SIGNATURE OF THE PARENT)
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Student Disability ID *
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DECLARATION BY THE STUDENT We have gone through all the provisions contained in the rules and regulations thoroughly and will abide these rules and regulations. I certify that the informations given above are true and correct. If my conduct, during my stay is found unsatisfactory, due to my negligence, misbehavior & indiscipline, I agree that I will abide by your decision. I will immediately vacate the hostel if ordered to do so.
I Agree