School Visit Form (OSMS / Career Insight)
Designation*	-Select Designation- Kiosk MPOnline Staff District Coordinator Other Please Select Designation
Name of Visitor*	Please Enter Name of Visitor Please Enter Valid Visitor Name	Mobile Number*	Please Enter Mobile Number Please Enter Valid Mobile Number
Email ID*	Please Enter Email ID Please Enter Valid Email ID	School Name*	Please Enter School Name Please Enter Valid School Name
School Type*	-Select School Type- Government Private Semi-Govt Please Select School Type	School Model type*	Model Excellence Other Please Choose School Model type
Education Stage *	Primary School Middle School High School Higher Secondary School Please Choose Education Stage
School UDISE Code*	Please Enter School UDISE Code	Principal/Contact Person Name*	Please Enter Principal/Contact Person Name Please Enter Valid Contact Person Name
State*	-Select State- ANDAMAN & NICOBAR ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATTISGARH DADRA & NAGAR HAVELI (UT) DAMAN & DIU (UT) DELHI (NCT) GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU & KASHMIR JHARKHAND KARNATAKA KERALA LAKSHADWEEP (UT) MADHYA PRADESH MAHARASTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ORISSA PUDUCHERRY (UT) PUNJAB RAJASTHAN SIKKIM TAMIL NADU TRIPURA UTTAR PRADESH UTTARAKHAND WEST BENGAL Please Select State	Ditrict*	-Select District Name- AGAR MALWA ALIRAJPUR ANUPPUR ASHOKNAGAR BALAGHAT BARWANI BETUL BHIND BHOPAL BURHANPUR CHHATARPUR CHHINDWARA DAMOH DATIA DEWAS DHAR DINDORI GUNA GWALIOR HARDA HOSHANGABAD INDORE JABALPUR JHABUA KATNI KHANDWA KHARGONE MANDLA MANDSAUR MORENA NARSINGHPUR NEEMUCH PANNA RAISEN RAJGARH RATLAM REWA SAGAR SATNA SEHORE SEONI SHAHDOL SHAJAPUR SHEOPUR SHIVPURI SIDHI SINGRAULI TIKAMGARH UJJAIN UMARIA VIDISHA Please Select District
Block*	-Select Block Name- Please Select Block	City Name*	Please Enter City Name Please Enter Valid City Name
School Address*	Please Enter School Address
Contact Number of School*	Please Enter Contact Number of School Please Enter Valid Contact Number	Principal Present?*	Yes No Please Select Principal Present?
Purpose of Visit*	-Select Visiting Purpose- OSMS Career Insight Both Please Select Purpose of Visit	Date and Time of Visit*	Please Choose Date and Time of Visit
Presentation/Demo Given?*	Yes No Please Select Presentation/Demo Given?	Reaction of School*	-Select School Reaction- Very Interested Interested Need More Info Not Interested Please Select Reaction of School
Questions or Concerns Raised*	Please Enter Questions or Concerns Raised
Lead Generated?*	Yes No Please Select Lead Generated	Service Interested In*	-Select Service Interested In- OSMS Career Insight Both Please Select Service Interested In
School Registered on OSMS?*	Yes No Please Select School Registered on OSMS	Next Step Suggested by School*	Please Enter Next Step Suggested by School Please Enter Valid Next Suggested
Next Action Required*	-Select Next Action- No Follow-up Required Email Visit Again Call Please Select Next Action Required	Preferred Date for Next Follow-up*	Please Enter Preferred Date for Next Follow-up
Remarks for Follow-up*	Please Enter Remarks for Follow-up Please Enter Valid Follow-up Remark
Verification : =