Application for Scholarship

Department of School & Mass Education, Government of Odisha

NOTE :- Applicants are allowed to apply schoolarship application for only once (Except SAMS Applicants) . For any kind of Modification in your applied application ,Kindly Contact the Head of the Institution.
Aadhaar Number is mandatory to avail Scholarship.
e-Medhabruti 2019-20* Mark indicates mandatory field
Scholarship Type * :



Applicant's 12 digit Aadhaar Number * :
Applicant's Name as on Aadhaar * :
Institute Type * :     
District * :
Institute Name  * :
Course Name * :
Subject Name * :
Roll No. * :
Date of Admission * :
Institute Name  * :
Institute Address  * :
Course Name * :
Subject Name :
Mobile Number (Principal)* : Institute Website (if any) :
Roll Number :
Date of Admission * :
District * :
Institute Name  * :
Stream  * :
Roll Number * : -
Date of Admission * :
State : Odisha    Other State District :
Institute Name  * :
Institute Address* : Institute Website (if any) :
Type of Course * : Duration of Course (in years) * :
Course Name* : Duration of Course (in years) * :
Entrance Name* : Rank* :
Institute Roll Number * : Date of Admission * :
Please Upload your Institute Identity Card* :

Full name of the Applicant as mentioned on the High School Certificate * :
District Name as mentioned on the High School Certificate or Residential Certificate * :
Date of Birth * : Gender * :
Nationality  * : Mother Tongue * :
Category * : Religion * :
Mobile Number * : PH/OH :
12 digit Aadhaar Number : Please Upload your Aadhaar* :
Note: 1. Upload legible scanned document between 100kb to 500kb in PDF format.
Name Profession Annual Income (in Rs.)
Father / Guardian *
Mother *
Total Income
Parent Income Certificate *
Note: 1. Upload legible scanned document between 100kb to 500kb in PDF format.
          2. Certificate to be issued by the competent authority i.e. Revenue Officer not below the rank of Tehsildar / Addl. Tehsildar.
State * : District * :
Block / ULB * : Address * :
PIN Code * :
Alternate Mobile Number : e-Mail * :
Resident Certificate* :
Note: 1. Upload legible scanned document between 100kb to 500kb in PDF format.
          2. Certificate to be issued by the competent authority i.e. from the concerned Tehsildar / Addl. Tehsildar. If parents are working
               under Government of Odisha; can produce resident proof from the employer.
Name of the last qualifying Examination * :
Name of Board / Council / University * :
Examination Roll No :
Year of Passing * :
Type* :
Mark Secured (Aggregate) * :
Maximum Mark (Aggregate) * :
Mark Sheet and Certificate
of last qualifying examination*
:
Note: 1. Upload legible scanned document between 100kb to 500kb in PDF format.
          2. Upload Mark Sheet & Certificate of the Last qualifying examination
Beneficiary Name * :
Account Number * :
(The bank account must be in the name of Applicant/Student)
IFSC Number * :
(For online money transfer through RTGS/NEFT)
MICR Code * :
Bank Details : * *
Bank Document* :
Note :1. Upload legible scanned document between 100kb to 500kb in PDF format.
          2. First Page of bank account containing account number and IFSC.
Helpline Toll Free Number :155335 / 18003456770