सामुदायिक स्वास्थ्य मिशन
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CarePay® | National Health Financial Inclusion Initiative Program
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Family Survey for Student Fee Support
Submit the survey form for student support
Progress
Section 1 of 8
1
Basic Information
2
Family Details
3
Financial Stress
4
Community Support
5
Government Aid
6
Borrowing Patterns
7
Support Model
8
Feedback
13% Complete
1
Basic Information
Parent/Guardian Names (At least one required)
*
State
*
Select State
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Andaman and Nicobar Islands
Chandigarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Jammu and Kashmir
Ladakh
Lakshadweep
Puducherry
Address
*
Mobile Number
*
Alternate Mobile (Optional)
Email Address
*
2
Family Details
Family Type
*
Nuclear Family
Joint Family
Single Parent
Migrant Family
Number of School-going Children
*
Select number of children
1 Child
2 Children
3 Children
4 Children
More than 4 Children
3
Financial Stress
Monthly Family Income
*
Select income range
Below ₹10,000
₹10,000 - ₹25,000
₹25,000 - ₹50,000
₹50,000 - ₹1,00,000
Above ₹1,00,000
Primary Income Source
*
Select income source
Salary/Wages
Self-Employed
Daily Wage
Small Business
Do you face delays in school fee payments?
*
Yes
No
4
Community Support
In Financial Crisis, Who Supports You?
*
Select primary support
Family Members
Friends
School
NGO/Community Organization
Government Program
None - I manage alone
Other
Do you feel socially isolated during financial stress?
*
Yes
No
Has School Ever Done Any of These?
*
Humiliated child in class about fees
Restricted participation in activities
Forced to sit separately
Denied access to school facilities
None of these
Other
5
Government Aid
Received Educational Financial Assistance from Government?
*
Yes
No
Banks/NBFCs Provided Short-term Zero-interest Help?
*
Yes
No
6
Borrowing Patterns
Ever Borrowed for School Fees?
*
Never
Bank
NBFC
Relatives
Friends
Employer
Moneylender
7
Support Model
Preferred Support Duration
*
Short-term (1-3 months)
Medium-term (3-6 months)
Long-term (6-12 months)
Ongoing support
Would you prefer confidential support?
*
Yes, definitely
Somewhat
No, not needed
Would you Recommend Program to Others?
*
Definitely
Maybe
Unlikely
Need more info
8
Open Feedback
What is your biggest concern about your child's education?
What kind of support would help you most?
*
Join Community Resilience Network?
*
Yes, I'm interested
Maybe later
No, not interested
Submit Survey
Basic Information
Please provide your contact details
Parent/Guardian Names (At least one required)
*
State
*
Select State
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Andaman and Nicobar Islands
Chandigarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Jammu and Kashmir
Ladakh
Lakshadweep
Puducherry
Address
*
Mobile Number
*
Alternate Mobile (Optional)
Email Address
*
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