Scholarship Application Form

ST&SC and MBC Welfare Department

Academic Year 2023-24
STSC92403014698859
Government of Odisha

Basic Information

Department Scheme Academic Year Application Type

ST&SC and MBC Welfare Post Matric Scholarship 2023-24 New
Department

Applicant Details

Applicant Name Category Applicant Gender

Sandhyarani Pradhan OBC/SEBC Female

Religion Date of Birth Aadhaar No.

Hindu 16 Mar 2005 (18 Year) XXXXXXXX3451
 Bank account is seeded with Aadhaar when applied by student.

Mobile No. Alternative Mobile No. e-Mail Id

9777789802 9777789802 magulipradhan7@gmail.com

Father's Name Father Educational Status Father Occupational Status

Manguli Pradhan Literate Agriculture

Mother's Name Mother Educational Status Mother Occupational Status

Laxmipriya Pradhan Literate House Wife

Guardian Name Individual/ Family Information

VIEW
Manguli Pradhan Beneficiary of NFSA

Address Information

District Block/ULB GP/Ward

Khurdha Tangi Pariorada

Village Pin Code Address

Pariorada 752023 PARIORADA, TANGI, KHORDHA

Educational Qualification Details

For : Matric-Annual

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

X BSE, Odisha 103BB0152 2020 600 287 47.83 Uploaded

Plus 2 CHSE, Odisha 123MA099 2022 600 403 67.17 Uploaded

Institute / Course Information (Current Education Information)

Institute Type
Pvt. Unaided

Institute District Block/ULB

Blue Wheel Institute of Nursing Sciences Nayagarh Ranapur

Nature of Course Course Branch/Stream/Trade

Self Financing Nursing General Nursing and Midwifery (G.N.M)

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

1st Year 25 05 Dec 2023

Enrollment No. Enrollment Date

25 05 Dec 2023

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 (%)

600 403 67.17

Certificate
Uploaded

Eligibility Information

Income Certificate No. Family Income (in Rs.) To Whom the Certificate Issued
E-INC/2024/07332   40000.00 MANGULI PRADHAN

Issuing Authority Issue Date Income Certificate

Revenue Officers not below the rank of 06 Jan 2024 Uploaded
Tahasildar / Additional Tahasildar

Matriculation Certificate No. Issuing Authority Matriculation Certificate

201130184 BSE, Odisha (Annual) Uploaded

Caste Certificate No. To Whom the Certificate Issued Issuing Authority

E-SEB/2023/618956  SANDHYARANI PRADHAN Revenue Officers not below the rank of
Tahasildar / Additional Tahasildar

Issue Date Caste Certificate

23 Dec 2023 Uploaded

Institute Declaration Certificate

NA

Bank Information

Account Holder Name IFSC Code Account No.

SANDHYARANI PRADHAN IOBA0003142 314201000010415

Whether account number tagged /seeded with the

Aadhaar number?
Yes

Bank Name Branch Name

INDIAN OVERSEAS BANK CHANDESWAR

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