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| No.___________________ | FIX PHOTOGRAPH![]() |
Course Applied For |
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| Name of the Applicant : (IN CAPITAL LETTER) |
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| Date of Birth : | |||
| Caste : | Nationality : | ||
| Father's/Guardian's Name : | |||
| Occupation of Father/Guardian: | |||
| Address : | |||
| Local Guardian's Name & Address (If Available) : |
Ph.No. |
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| Educational Qualification (STRING FROM, 10TH STANDARD): EXAMINATION %OF MARKS YEAR BOARD/UNIVERSITY |
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| LANGUAGE KNOWN | English Hindi Oriya | ||
| Read | |||
| Write | |||
| Speak | |||
| Extra Curricular Activities | |||
| Need for Hostel Accommodation : | Yes No | ||
| Details of Enclosures : | (A)
(D)
(F) Money receipt /GD No. |
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DECLARATION |
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| NB : To apply for admission into BASLP/ BPT, Please take a print out of the application and send the competed hard copy along with Photo copies of certificates to IHS | |||