Educational Help Form – drkpsedu.com

+91-9003178976

drkpseducharitrust@gmail.com

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We Rise By Lifting Others

DR.KPS EDUCATIONAL AND CHARITABLE TRUST

(Institute For Education & Social Works)

Reg No.58/2024, 12A & 80 G Approved, NGO DARPAN ID TN/2025/0492014

Online
Donattion

Through
Bank

Educational Help

1.Student Name *

2.Date of Birth

3.GenderTransgender FemaleTransgender MaleMaleFemale

Disabled personYesNo

4.Address

City

State/Province

ZIP / Postal Code

Country

Phone Number 1

Phone Number 2

5.A city near their hometown

Distance

6.Father Name

Age

Education

Is there a father?YesNo

Is the father in contact with the family?YesNo

WorkAgricultureAgricultural WagesConstruction Work100 days workWeaving Wages

Others

Daily wage Rs.

Monthly wage Rs.

7.Mother Name

Age

Education

Is there a mother?YesNo

Is the mother in contact with the family?YesNo

WorkAgricultureAgricultural WagesConstruction Work100 days workWeaving Wages

Others

Daily wage Rs.

Monthly wage Rs.

8.If there is no mother or father, who is the guardian?

Relationship System

9.CasteSTSC-ASCDNCMBCBC-MBCOCSrilankan Refugee

10.School name and city:10th STD:

Type of school:Government SchoolGovernment AidedSchool MatriculationPrivate School

School name and city:12th STD:

Type of school:Government SchoolGovernment AidedSchool MatriculationPrivate School

11.Language of instruction:

10thTamilEnglish

12thTamilEnglish

12.12th Group:Bio-MathsCS-MathsPure ScienceCommerceCS-CommerceBio-CS

Vocational Specification

12th Exam No:

13.Score obtained in the public examination

10th

11th

12th

14.Are you involved in extracurricular activities?YesNo

If yes, please specify.NCCNSSSportsDebateEssay Competition

Others

15.Are you the first generation student in your family to pursue a degree?YesNo

16.Desired course

17.Would you like to study in a hostel outside the city?YesNo

Otherwise, the reason for it

18.Has anyone you know benefited from DR.KPS EDUCATIONAL AND CHARITABLE TRUST?YesNo

If yesRelativeFriendFormer student of the school

Their name

College

19.Details of other family members excluding college parents

Name

Age

Relationship

Study

School or College Name/Occupation

School or College Fees/Annual Income

Do siblings study in private schools?YesNo

If yes, do they study with a fee concession?YesNo

Otherwise, how will you pay school fees?ParentsBank loansOther loans

20.If the house is occupiedOwnedRented

Or rented, the monthly rent is Rs.

21.House typeHutTileAsbestos/TinConcreteBuilt under government scheme

22.Has anyone in your family been affected by COVID-19?YesNo

If yesEconomic impactDeath in the familyOther

23.Have you applied to any other educational assistance organizations besides DR.KPS EDUCATIONAL AND CHARITABLE TRUST?YesNo

If yes, what systems?

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Contact Info

D No 3/462, Sekilar 1st cross street, Muneeswarar Nagar, Madurai North, Thiruppalai, Madurai, Tamil Nadu,625014.
9003178976, 6382048976
drkpseducharitrust@gmail.com

DR.KPS EDUCATIONAL AND CHARITABLE TRUST

(Institute For Education & Social Works)

Reg No.58/2024, 12A & 80 G Approved, NGO DARPAN ID TN/2025/0492014

Educational Help

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