For Official Use Only

Money Receipt No : Date of Submission at College :
Option Fees : Barcode No :
Postal Fees :

Note : All Fields Marked With (*) Are Mandatory

1. *Name Of Examination Board :
       (As In Admit Card)
2.*Applicant's Name : 3.*Select Gender :
4.*Father's Name: 5.*Fathers Occupation :
6.*Mother's Name : 7. *Mothers Occupation :
8.*Annual Income (Total) :
9.*Personal Details :
10.*Last School Attended :

12. Address For Correspondence
A. *State : B. *District :
C. *Block/ULB : D. *Pincode :
E. *Details
(Plot/Lane/Vill/PO/PS)
F. *Email :
 
G. Telephone : H. *Mobile :

13. Reservation Details (Please Tick In Appropriate Box)
A.   *
B.   
C.   
D.   *Are You an Outside State Application(OSA)?          If Yes,Please give the State Name :
E.   *Are you Oriya Living in Neighbouring State(OLNS)?          If Yes,Please give the State Name :

14. Weightage Details (Please Tick In Appropriate Box)
A. NCC
B. Scout & Guide
C. Sports

15. Details Of Marks Secured In 10th Board Examination
A. *Mark Secured in Subject :
B. *Have You Passed 10th Board
       Exam Compartmentally :
  
IF YES
Name of The Subject Marks Secured In Previous Exam Marks Secured In Compartmental Exam

Option(S)/Choice(S) Details
16. First Option
A. *Stream Name B. *Compulsory(MIL)
C. Elective Subject
D. 4th Elective
Want To Add Second Option   

17. Applicant's Image
B. *Upload Image :