INDIA SUDAR EDUCATIONAL AND CHARITABLE TRUST

Registered No: 454/2004 web: www.indiasudar.org mail: admin@indiasudar.org

Education for individual – Student Information Survey Form

PERSONAL DETAILS

1. Full Name (Block Letters) : CHANDRA PRIYA MUTYALU

2. Permanent Address: 10-1-63/18, Chinthalbasthi, Khairathabad, Hyderabad

Pin code :500004 phone no: 8096616682

3. Postal Address : (if it differs from permanent address)

Pin code : phone no:

4. E-mail ID (if any):

5. How do you know about India Sudar? IS member - Suresh

FAMILY DETAILS

Relation Full Name Ag Occupation/ Income per month/

e Education place of study
6. Father Not willing to disclose the details.

7. Mother Maheswari 30 House Keeping 2500

8. 1
Brother(s)

9. Sister(s) 1

Comments/ additional information if any: Her father married another lady and not taking care of this family
(Chandra Priya & Maheswari). Till last year, They applied for Gold loan and paid the Fees.

For office use only:

Requested Organization: Date:03 Apr 2011
Name of the Indiasudar Work Coordinator with Member code: Vijayashankar Bethamcharla (1161)

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CURRENT EDUCATION DETAILS

10.Name of the 11. Year of 2011-12

8th class
course Admission
12. Institution Name & Address 13. *Category P
G/GA/P
Shishu Sadan High School 12 months
14. Duration of
10-1-123, Near saifabad Science College,
the course
Hyderabad
Ph: 23393127 15.Percentage/Ma
rks obtained till 84
Pincode: Inst. Ph: 23393127 date
16. Tuition Fee 19. Hostel Fee
18. Book 20. Others if any 21. Total
(School/College fee 17. Exam Fee (excluding the
Fee (Uniforms etc.) (per year)
alone) mess fee)
School – 6000
500 2000 13300
Tuition – 4800
23.BC/MBC/SC/ST/ 26.
24. Amount 25. Stipend from other
22. Amount PH scholarship or Pending /
through organization
Contribution from any other Required
Education (Give the name of the organization
Parents/Relative scholarship amount
Loan and amount in Rs.)
if any (Rs.)
400 per month 0 0 0 8500
(Total 4800 per
year) from her
mother
27. Last date to pay the fee: 20th June 2011 (approximately)

28. Mode of payment : DD/Cheque in favour of ________(They pay the amount by hand in the school. )

*( G- Government GA- Government Aided P- Private)

PAST EDUCATION DETAILS (Fill whichever applicable)

29. Class Name of School/College *Categor Year % Marks

y
G/GA/P
6th Same as above 2008-09 84

Same as above 2007-08 81

5th
Any other if any Awaiting 7th class results.

QUESTIONNAIRE (Please fill carefully. All particulars will be verified. Application will be rejected if found wrong)

30. Do you have own house? NO

(if Yes, approximated value of the house Rs._____________ Square feet _________ Type of
house_____________ )

31. Do you have own land? if Yes, Square feet _______No

32. Do you want to return this money (without interest) after joining any job? YES

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33. Have you tried for Education loan? (If No, specify the reason) No

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