A. School Information Form

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1 Form No. - H 1/2 Name of Rotary / Inner Wheel / Rotaract Club District Number. Before proceeding further, please answer: i. A. School Information Form Does the school have a School Management Committee (SMC), as required under the RTE Act? If 'yes', is the SMC functioning regularly? (Ask the parents of several students of the school) i Has the school prepared an Annual Development Plan (ADP) for or , as required under the RTE Act? If yes, briefly describe the facilities envisaged in the ADP corresponding to those under the Happy Schools Project Facilities 1 Provision for Painting, Repairs and Security Provisions in School Building 2 Provision for Clean and Hygienic Separate Toilets for Boys and Girls 3 Provision for Safe and Adequate Drinking Water Facilities 4 Provision for a Functioning Library 5 Provision for Uniforms and Footwear 6 Provision for Play Materials and Sports Equipment 7 Provision for Benches and Desks v. 8 Provision for Well-maintained Space for Teaching Staff Proceed to the School Information Form below if (a) there is no ADP or (b) after taking into account the ADP provisions, the school still lacks any five facilities specified for Happy Schools 1 P a g e

2 (Government/ZillaParishad/Municipal Schools only) 1. Name of School 2. School Address (Village/Town, Block/Taluka, District, State) 3. School Type Primary (Class I V) Elementary (Class I VIII) Secondary (Class I X) 4. Students (Boys) : Students (Girls) : Total Students : 5. Teachers Male Female Head Teacher Total 6. Trained Teachers Male Female Trained Head Teacher 7. School Building (Current Status) i. Structure Good Average Poor Part of Structure Extent of Damage a. Roof Below 50% Above 50% b. Floor Below 50% Above 50% c. Walls Below 50% Above 50% d. Doors and Windows Below 50% Above 50% i Total no. of Rooms in the School Building Class Rooms v. Is there a separate room for a. Head Teacher b. Teaching staff c. Stores (separate) d. Stores (along with the Head Teacher's room) e. Laboratory f. Kitchen only, for mid-day meals g. Kitchen and space for eating mid-day meals vi. Is there electricity supply? v Is the building secure against unauthorized entry during non-school hours? vi If, no, how do you propose to provide security? ix. a. Is there an open play ground b. Any sporting equipment available? x. Indoor games or play equipment for students 8. Medium of Instruction i. 1 st Language : 2 nd Language : 3 rd Language : 9. Continuous and Comprehensive Evaluation (CCE) 2 P a g e

3 i. Please ask the Head Teacher (in the absence of Head Teacher, the senior-most teacher) if he/she has heard of CCE for students a. If yes, please ask him/her whether any booklet or instructions on CCE has been received b. If again yes, please ask him/her to show the booklet and briefly summarize what it says i a. b. Is there any arrangement for helping lagging children with their studies during/after school hours? If there is no such arrangement, please ascertain if the school plans to start such supplemental teaching and if so, when 10. a. Are there computers in the school? b. If yes, how many functioning computers are there? 11.a. Are there e-learning facilities available at the school? b. If, yes, please describe the e-learning facilities available. 12. Are there any physically or mentally challenged children in the school? i. If 'yes', please briefly describe the facilities for teaching such children and the nature of training of the teacher/s in charge If 'no', please ascertain if the school is willing to take in such children and the type of assistance it needs to teach such children B. Form for Recording Specific Features Relating to Happy Schools Selection Criteria & Cost Estimation 1. Does the school building need repairs? i. If 'yes', please describe the type of repairs needed to Approx. area (sq. ft.) Rate (Rs. per sq. ft.) Estimated total cost (Rs.) a. Roof c. Floor d. Walls e. Doors and Windows g. Estimated total cost (Rs.) 2. Does the school building need painting? a. Total Area (sq. ft.) needing painting 3 P a g e

4 3. b. Estimated total cost of painting (Rs.) c. Type of Paint Does the school building have sufficient benches and desks in each class room? If 'no', please give the details a. benches b. desks c. bench-desk sets existing being provided Estimated total cost (Rs.) 4. Does the school have adequate and safe drinking water supply? i. If, no, please provide a descriptive account of the existing facility Is the water potable (safe)? Estimated total cost to ensure safe and adequate drinking water Yes/ No Rs Does the School have: i. a. separate toilet for girls in usable* condition (toilets to which both boys and girls have access at present are to be treated as boys' toilets) b. If yes, no. of urinals no. of toilet seats a. separate toilet for boys in usable* condition b. If yes, no. of urinals toilet seats i a. separate toilet for Teachers in usable* condition b. If yes, no. of urinals no. of Toilet seats * usable is defined as having doors that can be closed and sufficient flowing/stored water for washing. In case there are no usable toilets at all or there are common toilets for boys, girls and teachers, please assess and record, separately the number of toilets to be constructed existing toilets No. to be provided Estimated cost of toilets (Rs.) a. Boys b. Girls c. Teachers 6. Does the school have a functioning library with books i. Do the students use the library (ask students, in particular) Briefly describe the type of books available in the library i Number of Books Existing books to be provided Estimated Cost of setting up a useful library(rs.) 7. (It is assumed that you are using books collected in the Book Collection Drive) Is the Government supplying school students uniforms and footwear free of cost 4 P a g e

5 i. If no please briefly state the reasons for non-supply of uniforms and footwear. Cost of supplying to each student of (classes I to VIII) Cost (Rs. per unit) Estimated total cost (Rs.) a. Uniforms (2 pairs) b. Footwear (2 pairs) c. Both (2 pairs each) (It is suggested that your Club make provisions for new uniforms for the subsequent 3 years also as a measure of sustainability) 8. Space for Teachers i. Is the space/room for teachers sufficient? If no, describe details of availability of space i What are the facilities available in this space/room? Estimated total cost (Rs.) of creating and equipping adequate space for teachers 9. Are indoor sports/games facilities available in the school i. a. If yes, list facilities available/to be upgraded b. If no, list facilities to be provided Estimated cost of Indoor sports/games facilities (Rs.) 10. Total estimated cost for the school to be converted into a Happy School Form filled in by Designation Id: Mobile Number Date: Form Verified by Designation Id: Mobile Number Date: 5 P a g e

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