File No.

SOW02-16021/85/2022-D2 SEC-COSW

Jagananna Vidya Deevena - Renewal Registration Application for

2022-23 Academic Year
Name of the college:
1. Name of the student:
2. Application ID for 2021-22 academic year:
3. Course : Course Year for 2022-23:
4. Mobile Number of student:
5. Mobile number of mother:
6. Adhar number of mother:
7. In case mother is not available/died, mention details of guardian
(father/ or relative):
Name of guardian: Aadhaar of guardian:

Relationship with student:

8. Adhar number of father:
9. Details of previous course (prior to the present studying
course):
a. Name of the course: b) % marks in that course:
10.Details of marks in previous year of present studying course
(of 2021-22 academic year):
a) Hall ticket number: b) Pass/Fail c) Marks
d) percentage/GPA:
11.Present address of the student:
12.Name of the Mandal/Municipality:
13.Name of the Village/ward Secretariat:
14.Income Related Criteria (as per Go MS No. 115 of SW Dept dated
30-11-2019)
i. Is Annual income of all family members together is more than
Rs.2.50 lakhs? Yes/No
ii. Is any family member of your family is Govt.
Employee/Pensioner? Yes/No
(Except Sanitation Worker)
 File No.SOW02-16021/85/2022-D2 SEC-COSW

iii. Is any Family Member of your family paid Income Tax in the
past? Yes/No
iv. Did any Family member own Four-Wheeler? (Except taxis/
Tractors) Yes/No
v. Is your family having more than 10 acres wet or 15 acres Dry
or 25 acres of wet/dry land?
Yes/No
vi. Is your family having 1500sq.ft Property in urban
Area? Yes/No

15. In case of EBC students, mention the sub-caste: ___________

16.Is mother or father a sanitation worker in local body (in which case
student is eligible, irrespective of salary of parent): Yes/No
17.Is student a day scholar or staying in Govt welfare Hostel (DAH) or
College attached hostel (CAH) ?
18.Is the fee released by govt during previous year to mother paid to
the college: Yes/No
I request to renew my application for JVD schemes for 2022-23
academic year.

Signature of parent Signature of the student

Kati Harshavardhan Ias

Director