Scholarship Application Form
ST&SC and MBC Welfare Department
Academic Year 2022-23
STSC92212282621174
Government of Odisha
Basic Information
Department Scheme Academic Year Application Type
ST&SC and MBC Welfare Post Matric Scholarship 2022-23 New
Department
Applicant Details
Applicant Name Category Applicant Gender
Aparupa Khatua OBC/SEBC Female
Religion Date of Birth Aadhaar No.
Hindu 16 Mar 2001 (21 Year) XXXXXXXX4642
Mobile No. Alternative Mobile No. e-Mail Id
9348754368 9348754368 aparupakhatua04022@[Link]
Father's Name Father Educational Status Father Occupational Status
Pramod Khatua Literate Agriculture
Mother's Name Mother Educational Status Mother Occupational Status
Banita Khatua Literate House Wife
Guardian Name
Pramod Khatua
Address Information
District Block/ULB GP/Ward
Cuttack Tigiria Gadadharpur
Village Pin Code Address
Harisaranpur 754030 At-harisaranpur, po-Gadadharpur, block-tigiria,
dist-cuttack , pin- 754030,Odisha
Educational Qualification Details
For : Matric-Annual
Passing Total Secured Percentage Marksheet/
Course Board Roll No. Year Mark/CGPA Marks/CGPA (%) Certificate
X BSE, Odisha 066AA007 2016 600 506 84.33 Uploaded
Plus 2 CHSE, Odisha 307CA014 2018 600 443 73.83 Uploaded
Plus 3 Utkal UNPHY18040 2021 2600 2072 79.69 Uploaded
University
Institute / Course Information (Current Education Information)
Institute District Block/ULB
Udayanath (Autonomous) College of Science & Cuttack Kantapada
Technology, Adaspur
Nature of Course Course Branch/Stream/Trade
Self Financing M. Sc. Physics
Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date
1st Year 13 26 Nov 2022
Enrollment No. Enrollment Date
13 26 Nov 2022
Any Exam Conducted during current academic year? : No
Residential Status
Whether
Hosteller
Date of Admission in Hostel Hostel Details No. of Months
08 Dec 2022 Residing in institution run hostel within 10
institution campus
Hosteller Bonafide Certificate
Uploaded
Details of Last Exam Passed
Course Course Year Passing Year
Plus 3 3rd Year 2021
Total Mark/CGPA Secured Marks/CGPA Percentage (%)
2600 2072 79.69
Certificate
Uploaded
Eligibility Information
Income Certificate No. Family Income To Whom the Certificate Issued
E-INC/2022/1394024 48000.00 Pramod kumar Baske
Issuing Authority Issue Date Income Certificate
Revenue Officers not below the rank of 17 Nov 2022 Uploaded
Tahasildar / Additional Tahasildar
Matriculation Certificate No. Issuing Authority Matriculation Certificate
1601004227 BSE, Odisha (Annual) Uploaded
Caste Certificate No. To Whom the Certificate Issued Issuing Authority
E-SEB/2021/328152 Pramod kumar Baske Revenue Officers not below the rank of
Tahasildar / Additional Tahasildar
Issue Date Caste Certificate
09 Oct 2021 Uploaded
Institute Declaration Certificate
NA
Bank Information
Account Holder Name IFSC Code Account No.
Aparupa khatua PUNB0093620 0936010516358
Whether account number tagged /seeded with
the Aadhaar number?
No
Bank Name Branch Name
PUNJAB NATIONAL BANK NUAPATNA
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