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Application For Free Laptop Distribution
DOB
AGE
UDID Certificate Number
Name Of The Student
Father's/Spouse Name
Permanent Address
Present address same as permanent address....
Present Address
Disability Type
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Low Vision
Blindness
Disability %
Mobile No
Gender
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Male
Female
Other
District
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ANUGOLA
BALANGIR
BALESHWAR
BARAGADA
BHADRAK
BOUDH
DEBAGADA
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHAPUR
JAJPUR
JHARSUGUDA
KALAHANDI
KANDHAMALA
KATAKA
KENDRAPADA
KENDUJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NABARANGAPUR
NAYAGADA
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SONPUR
SUNDARAGADA
Photo
Upload Image (.JPG/.JPEG Format is Allowed)
Aadhar No
Aadhar Scan Copy
Upload Disability Certificate
Name Of The Institution
Name Of The Course
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Bachelor
Master
Phd
Other
Year Of Study
Whether Free Laptop Received Earlier ?
Yes
No
Undertaking
I declare that the above information(S) are true and correct to the best of my knowledge.
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