SSEPD::Social Security & Empowerment of Persons With Disabilities Department

Application For Banishree Scholarship

Student Details

Apply For Academic Year

Name

Aadhar No

Gender

DOB

AGE

Social Category(Caste)

Citizen Of India

Yes No

State

Nature Of Disability

UDID Certificate Number

Upload Disability Certificate

Nature Of Scholarship

Fresh Renewal

Have you ever received Scholarship under any other scheme?

Yes No

Class in which you received the scholarship?

If you are visually challenged students, indicate if you have engaged a reader?

Yes No

If you are Orthopaedically handicapped students being 75% and above disability, indicate the mode of transport.

Mobile No

Aadhar Card Scan Copy

Institute Details

Studying Inside Odisha ?

inside Outside

Institute Name

District

Sub-division

Address Type

Block

Village

House No/Plot No

Class Type

Under Matriculation
Above Matriculation

Scholarship Applying Class

Admission Date

Do you want to upload Mark-sheet of last examination passed?

Yes No

Monthly Income

Additional Document

Bank Account Details :

Bank Account Type

Account Holder Name

Account Number

Choose IFSC Code

Student Details

Institute Details

Other Details

Bank Account Details :