DIGJYOTI

CHARITABLE EDUCATIONAL TRUST FOR ORPHAN AND POOR

Regn. No.130/06/dt.5-1-2006 (Registered under Trust Act)
C-24/HIG, Housing Board Colony, Baramunda, Bhubaneswar-751003
Tel: 0674-2555252

APPLICATION FOR DIGJYOTI SCHOLARSHIP Attach recent

(To be filled in by the Applicant) passport size
Photograph

1. Name (in Block Letters), :

Address, Mobile
No/Whatsapp No & Email ID
of the candidate:

2 Name of Father & Mother :

3. Date of Birth of the :

applicant
4. If inmate of an Orphanage, :
give Name, Address, Mobile
No & Email of the Orphanage

5. Brief background of the

applicant :
(attach Xerox copy of
supporting certificates) :
(a) Family’s annual income
(b) If orphan, whether by
death of one or both :
parents

(c) Whether belongs to SC/ST :

(d) If disabled, give details
6. Educational Career (Attach Xerox copy of certificates/ marksheets)

Examination Name & Address of the Year of % of Division/Grade

passed School/College Passing Marks

7. Name of the Course and :

Year in which the applicant
is studying ?

8 Name & Address of the

College/Institution where
admitted.
(attach Xerox copy of
Admission Receipt)

9 If received assistance from

DIGJYOTI in previous
year(s). Give details:

10 Assistance received if any, :

from any other source (give
details)

Date: Full Signature of the candidate

___________________________________________________________________________

Endorsement of the Head of the College recommending assistance for the

candidates.

Date: Signature of Head of the College

With seal