JOY OF GOD ORPHANAGE CHILD DATA COLLECTION FORM

Section A: Personal Information

Full Name: Elisha Yakobo Jambi

Date of Birth: 01/July/2013

Age: 12

Gender: Male

Place of Birth: Mount Meru Hospital

Short Background/Story

His mother, a handicapped woman, did not know who had impregnated her and was carrying an unwanted pregnancy. The mother has since passed away. When the child was 8 years old, he was brought in by the social welfare.

Section C: Education Information

Current School: Kaloleni

Class/Grade: VI

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

Section D: Health Information

Known Medical Conditions: NIL

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: He Don’t have