AKSA FOUNDATION | Application Form

Application Form

Name of the Child *

Date of Birth *

Gender *

Category of Disability / Disorder *

Address

Email *

Phone *

Father's Name & Occupation *

Mother's Name & Occupation *

Mother Tongue

Guardian's Name *

Birth and Medical History –(In brief)

Last School Attended

Previous Academic Level

Earlier reports (PLEASE ATTACH SEPARATELY) of assessment and students performance report of the school. Previously attended if any ;

Reasons for Approaching Our Center & Referred By

Program to be Enrolled in "AKSA"

This is not an intake form.
Parents will be informed on the admission confirmation only after the child’s observation/evaluation.
If admission granted, the parents accept to abide the terms and conditions of ‘AKSA’.
Enclose the reports & current therapy services of the child.