::SDTAP ::

YOUTH SURVEY FORM
*Indicates Fields are Mandatory

E 1
Personal Details
       Form No *
Surname *
First Name *
Middle Name
Gender * Male Female Marital Status * Unmarried Married
Caste * Date of birth *

Physical Details
Height ( Feet ) Weight ( kg )
Blood group Disability (if any) * Yes No

Contact Details
Phone Number Mobile Number *
Email ID

Personal Identification
Passport number AADHAR / UID number
Family Ration Card Number EID Number
Name of SHG and details Employment Registration No.
Driving License number Driving License valid upto
Driving License Type LVM HVM Educational Status *

Applicants Correspondence Address
District * Taluka *
Name Of Village * House Number
Location Street Name
Post Pin code


E 2
PAP's Land Details
 Surname Of Original PAP *
Name Of Original PAP *
 Middle Name Of Original PAP
Relation with original PAP *
District *               Taluka *                
Name Of Village * House NO. *                  
Post *                   Pincode *                      
File No               Award Number      
Node *                Survay No / Hissa No

Father's / Guardian's Address
Surname *
First Name *
 Middle Name
Address *
Mobile Number * LandLine No with Code

E 3
Name and Contact No of Your Best Friends
# SurName First Name Middle Name Phone No. /Mobile No
1
2

E 4
Housing Status
Housing Status Own House Rented Rent Free Hut
Tiled/Asbestos Pucca House
Others (Please Specify)

Who is your role model from the Village? Why?
Surname First Name Middle Name
Position/Designation
His/Her Mobile No Landline No
Description/Remarks

Languages Known
Marathi Speak Read Write English Speak Read
Write
Hindi Speak Read Write
Other Language (if any)     Yes No

E 5
Details of the Applicant's Family
# Surname First Name Middle Name Relation Age Education Service /
Occuption
Annual
Income ( ₹   )
Remarks
1

E 6
Educational Details Note : Enter Highest Qualification in First Row
# Educational Qualification * Stream Year of Passing % of marks Name of School /College Whether got
stipend or not?
1 Yes No


E 7
Vocational Skill Details
# Type of skills obtained
/ Undergoing training
Year in which
skill obtained
Duration of
training (Days)
training in
progress
Name , address of the
Institute & Phone No
1

E 8
Work Experience
# Organisation Name Sector Designation Years of
experience
Income
(Approx. Monthly)
1

E 9
Select any one of the following * Coaching Classes for Competitive Exams
Skill Development Program
Direct Placement




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