EWDNA
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Basic Info
Full Name
Mother's name
Date of Birth
Phone
E-mail
Address Details
City
Woreda
House No
Post Number
Place of Birth
Disability Info
Disability Type
---Choose disability type---
Vision Impairment
Deaf or hard of hearing
Mental health conditions
Intellectual disability
Acquired brain injury
Autism spectrum disorder
Physical disability
Cause Of Disability Type
---Choose Cause of Disability---
Accident
Health Issues
Innate(Inborn)
Received Medical Help After Injury
Yes
No
Support Material Being Used
Academic Achievements
Education Level
---Choose Education Level---
No Academic Background(
Primary School(KG-4 Grade)
Secondary School(5-8 Grade)
High School(9-12 Grade)
Preparatory School(11-12 Grade)
University/Collage Student
Degree Holder
Diploma
Certificate Holder
Other(Mention it in other note Section)
Name of School
Address of School
Ambition
Reason for Suspension
Accessibility of School
Not Accessibility of School
Family Status
Guardian
Are parents alive?
Yes
No
Number of Sibilings
Number of Sisters
Number of Brothers
Family Income Details
Do you have A job?
Yes
No
Job Title
Place of Work
Name of Company
Marital Status
Single
Married
Divorced
Number of Children
Family Income Source
Reason of Interest to Membership
Source of Information
expectation
Comment
Offer
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