cover pros - IGNOU

INDIRA GANDHI NATIONAL OPEN UNIVERSITY
(TO BE SUBMITTED ONLY AT THE CONCERNED REGIONAL
(JULY / JANUARY SESSION)
CENTRE)
C E S E
11. Category
(Write the
relevant
code in
the box)
A1 - GEN C3 - ST
B2 - SC D4 - OBC
(I n c a s e o f O B C s t u d e n t , P l e a s e
a l s o i n d i c a t e c o d e e i t h e r )
D4 -A or D4 - B
( i ) Cremy Layer - D4-A
( ii ) Non-Cremy Layer D4B
20 (a) Your relationship with the child with disability. (Please tick whichever is applicable. You are required to certify that you live in the same household as the child).
A1 Mother
B2 Father
Any other (please specify),
b) Particulars of the child with disability
i) Name of the child (use block letters)
ii)
iii)
iv)
Sex of the child;
Age of the child................................................... Date of birth:
Date Month Year
Nature of Disability of Child
A1 Brother
B2 Sister
A1 Uncle
B2 Aunt
A1 Male
B2 Female
A1 Grand Master
B2 Grand Father
20(c) Whether completed any of the Awareness-cum-Training Packages in Disability (Cerebral Palsy, Mental Retardation, Visual Impairment, Hearing Impairment).
A1 Yes
B2 No
20(d) Whether having direct experience of working with persons with disabilities?
A1 Yes
B2 No
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