JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Application for Vidya Gyan Assistance to Covid-Affected Family (ACAF)
Please fill in N/A (Not Applicable) if any of these do not apply to you.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Teacher's first and last name
*
Your answer
School
*
Your answer
Phone number
*
Your answer
Teacher's Email:
*
Your answer
Is mother in family currently living?
*
Yes
No
If yes, her name, village, occupation, and phone
Your answer
If no, date of death for mother (Date, Month, Year)
Your answer
Is father in family currently living?
*
Yes
No
If yes, his name, village, occupation, and phone
Your answer
If no, date of death for father (Date, Month, Year)
Your answer
Name of children and their class; like Aarti (8), Prem (6), Arjun (5)
*
Your answer
Does the family have a corona related death certificate?
*
Yes
No
Does the family have a bank account?
*
Yes
No
If yes, what bank? (account number not needed)
Your answer
Has family already applied under scheme (A) or (B)?
*
Yes
No
If yes, which scheme?
Scheme A
Scheme B
Clear selection
When did the family apply? (Date, Month, Year)
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
