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    Scholarship

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    mr.uniq00

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    © All Rights Reserved
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    Scholarship

    Uploaded by

    mr.uniq00
    37 views3 pages

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    scholarship

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    37 views3 pages

    Scholarship

    Uploaded by

    mr.uniq00

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    © All Rights Reserved
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    Scholarship Application Form

    ST&SC and MBC Welfare Department


    Academic Year 2022-23
    STSC92210302023965
    Government of Odisha

    Basic Information

    Department Scheme Academic Year Application Type


    ST&SC and MBC Welfare Post Matric Scholarship 2022-23 Renew in New Course
    Department

    Applicant Details

    Applicant Name Category Applicant Gender


    Ghanashyama Mahunta OBC/SEBC Male

    Religion Date of Birth Aadhaar No.


    Hindu 06 Oct 2004 XXXXXXXX1568

    Mobile No. Alternative Mobile No. e-Mail Id


    8598098794 7847808191 ghanashyamamahunta@gmail.com

    Father's Name Father Educational Status Father Occupational Status


    Trilochan Mahunta Literate Daily Wage Earner

    Mother's Name Mother Educational Status Mother Occupational Status


    Ranjana Mahunta Literate House Wife

    Guardian Name
    --

    Address Information

    District Block/ULB GP/Ward


    Ganjam Kabisuryanagar Paikajamuna

    Village Pin Code Address


    Nimundia 761104 At- NIMUNDIA, MAJHISAHI PO- PAIKA
    JAMUNA, BLOCK-
    KABISURYANAGAR,GANJAM.

    Educational Qualification Details

    For : Matric-Annual

    Course Board Roll No. Passing Year Total Mark/CGPA Secured Marks/CGPA Percentage (%) Certificate

    X BSE, Odisha 299DB0158 2020 600 459 76.50 Uploaded

    Plus 2 CHSE, Odisha 338EA080 2022 600 446 74.33 Uploaded

    Institute / Course Information (Current Education Information)

    Institute District Block/ULB


    Science College (Autonomous), Hinjilicut Ganjam Hinjilicut Mpl

    Nature of Course Course Branch/Stream/Trade


    Self Financing Bachelor of Computer Application (BCA) Bachelor of Computer Application (BCA)

    Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date


    1st Year BCA22-1212 13 Oct 2021
    Enrollment No. Enrollment Date
    BCA22-1212 30 Aug 2022

    Any Exam Conducted during current academic year? : No

    Residential Status

    Whether
    Day Scholar

    Details of Last Exam Passed

    Course Course Year Passing Year


    Plus 2 2nd Year 2022

    Total Mark/CGPA Secured Marks/CGPA Percentage (%)


    600 446 74.33

    Certificate
    Uploaded

    Eligibility Information

    Income Certificate No. Family Income To Whom the Certificate Issued


    E-INC/2022/1176020   62000.00 TRILOCHAN MAHUNTA

    Issuing Authority Issue Date Income Certificate


    Revenue Officers not below the rank of 25 Sep 2022 Uploaded
    Tahasildar / Additional Tahasildar

    Matriculation Certificate No. Issuing Authority Matriculation Certificate


    201468250 BSE, Odisha (Annual) Uploaded

    Caste Certificate No. To Whom the Certificate Issued Issuing Authority


    E-OBC/2020/46404  GHANASHYAMA MAHUNTA Revenue Officers not below the rank of
    Tahasildar / Additional Tahasildar

    Issue Date Caste Certificate


    17 Sep 2020 Uploaded

    Bank Information

    Account Holder Name IFSC Code Account No.


    GHANASHYAMA MAHUNTA SBIN0002073 37079007105

    Whether account number tagged /seeded with


    the Aadhaar number?
    Yes

    Bank Name Branch Name


    STATE BANK OF INDIA KABISURYANAGAR

    Passbook front page


    Uploaded
    Student Declaration

    1. I have read and understood the conditions of award of Scholarship.


    2. I am aware that my application is liable to be rejected, if it is found at any stage, that Aadhaar number provided by me is wrong or Aadhaar number is of
    someone’s else.
    3. I am aware that if more than one application is found, all my applications are liable to be rejected.
    4. I am aware that for any wrong entry or mis-match of the Bank-account details, the State Government will not be responsible for mis-credit and I will be
    held responsible for diversion of public money on this ground.

    Date ........................

    Place ........................ Full Signature of Applicant

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