JOY OF GOD ORPHANAGE CHILD DATA COLLECTION FORM

Section A: Personal Information

Full Name: Hadija Mohamed Juma

Date of Birth: 00/00/2013

Age: 12

Gender: Female

Place of Birth: Zimuye Tanga

Short Background/Story

Her mother is mentally ill and had harmed the child several times. She even had a bite wound caused by her mother. She was eventually brought to social welfare by his class teacher after the teacher learned about the child’s problems.

Section C: Education Information

Current School: Kaloleni

Class/Grade: V

School Performance (Last Exam Grade/Remarks): Grade C

Section D: Health Information

Known Medical Conditions:

Allergies: NIL

Disability (if any): NIL

Vaccination Status: I don’t know

Section E: Sponsorship Information

Type of Sponsorship:

   • Education: 0%

   • Health: 0%

   • Food/Nutrition: 0%

   • Clothing: 0%

Other: She Don’t have