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CommonВ ApplicationВ Form

forВ AdmissionВ toВ HigherВ SecondaryВ Classes

DepartmentВ ofВ HigherВ Education, В GovernmentВ ofВ Orissa

ForВ officeВ useВ only MoneyВ ReceiptВ­cumВ­В IndexВ Number

(MainВ Form)

TheВ applicationВ formВ shouldВ beВ filledВ inВ CAPITALВ LETTERВ only. 1 NameВ ofВ theВ BoardВ fromВ whichВ youВ haveВ passedВ the 10th, В YearВ & В ExaminationВ RollВ NumberВ (AsВ inВ admitВ card) Board/ State YearВ of Passing 10thВ Board RollВ No.

a couple of

TotalВ no. В ofВ choicesВ youВ haveВ optedВ (MainВ & В Addl. В Form)

ThisВ applicationВ formВ isВ validВ forВ admissionВ toВ 60В JuniorВ Colleges sВ (i. at the. В 51В GovernmentВ JuniorВ CollegesВ & В 9В LeadВ AidedВ JuniorВ Colleges)

FullВ nameВ of several theВ applicant 5 Father'sВ Name AffixВ yourВ selfВ attestedВ (onВ theВ front)В recent colourВ passportВ sizeВ photographsВ hereВ

5 Mother'sВ Name (IfВ parentsВ areВ notВ aliveВ pleaseВ giveВ guardian'sВ nameВ & В address) six AddressВ forВ Correspondence a. HouseВ No. w. Street/Village c. PostВ Office electronic. PoliceВ Stn. g. State we. TelephoneВ (withВ STDВ Code) ( ) j. j MobileВ (forВ SMSВ Service) k. e‐MailВ Address 7 PermanentВ AddressВ (ItВ mayВ notВ beВ filledВ up, В ifВ PermanentВ AddressВ isВ sameВ asВ CorrespondenceВ Address) a. HouseВ No. n. Street/Village c. PostВ Office e. PoliceВ Stn. g. State my spouse and i. TelephoneВ (withВ STDВ Code) 8 PersonalВ Details a. BloodВ Group e. CategoryВ[PutВ В tickВ ( e(1)

deb. Block/ULBВ f. District l. PINВ Code

g. Block/ULBВ farrenheit. District l. PINВ Code

m. Sex

c. Religion

deb.

DOB

D

D

as well as

M

Meters

/

Y

Y

Sumado a

Y

ForВ 8(c)В code, В i. e. В Religion, В pleaseВ referВ toВ InstructionВ Manual

)В belowВ theВ categoryВ applicableВ inВ theВ box]

e(2)

Booking SC STREET PH/OH ESM SDP CoM

Weightage ScoutВ Guide PR RP Sports S i9000 N IN

NCC A C

f. WhetherВ youВ areВ anВ OutsideВ StateВ ApplicantВ (OSA)? В (Y/N) g WhetherВ youВ areВ anВ OriyaВ LivingВ inВ NeighbouringВ StateВ (OLNS)? В (Y/N) they would. AreВ youВ employed? В (Y/N) 9 Nationality 11 Father'sВ Occupation 13 AnnualВ IncomeВ ofВ theВ ParentsВ (Together)В in Rupees IfВ yes, В thenВ pleaseВ giveВ NOC/IncomeВ CertificateВ fromВ theВ organistaionВ whereВ youВ areВ engaged.

10 MotherВ Tongue 12 Mother'sВ Occupation

13 HaveВ youВ passedВ 10thВ BoardВ ExaminationalВ Compartmentally? В (Y/N)

e-College | SAMS | CAF

Candidates applying in two or more Common Application Forms (CAF) are prone to be rejected.

1 of 11

12-15 MarkВ securedВ inВ eachВ subjectВ inВ 10thВ BoardВ Examination FL SL TL Math Science SocialВ Studies FLORIDA: В FirstВ Language, В SL: В SecondВ Language, В TL: В ThirdВ Language 16 RecordВ ofВ educationalВ institutionВ lastВ attended NameВ ofВ theВ Institution/School

TotalВ MarkВ Secured

MaximumВ Mark

Location

DistrictВ Name

YearВ of Joining

YearВ of Leaving

seventeen IfВ youВ areВ notВ aВ freshВ candidate, В pleaseВ putВ tickВ (

)В inВ theВ appropriateВ box

Jailed

Discontinued

ThisВ applicationВ formВ isВ validВ forВ admissionВ toВ 60В JuniorВ Colleges sВ (i. e. В 51В GovernmentВ JuniorВ CollegesВ & В 9В LeadВ AidedВ JuniorВ Colleges)

PutВ CollegeВ & В StreamВ codesВ accordingВ toВ availabilityВ inВ respectiveВ collegesВ inВ orderВ ofВ preference. 18 ForВ MILВ (Compulsory)В & В ElectivesВ pleaseВ useВ codeВ fromВ itemВ No. В 3В ofВ InstructionВ ManualВ (AnnexureВ­V). В UseВ AdditionalВ FormВ forВ moreВ thanВ 13В options.

CollegeВ Code CollegeВ Name OptionВ­01 SubjectВ Combination

Compulsory

Elective(1)

StreamВ Code

UseВ '01'В forВ Arts, В '02'В forВ Sc. В & В '03'В forВ Comm.

IfВ admitted, В IВ proposeВ toВ resideВ[PleaseВ tickВ (

)В inВ theВ appropriateВ box)

MILВ (В В В В В В В В В В В В )

Elective(2) Elective(3)

1 three or more

InВ collegeВ hostel WithВ parents

2 some

WithВ localВ guardian InВ privateВ accommodation

4thВ ElectiveВ inВ orderВ ofВ preference 1 2 a few

CollegeВ Code CollegeВ Name OptionВ­0 02 SubjectВ Combination Required

Elective(1)

StreamВ Code

UseВ '01'В forВ Arts, В '02'В forВ Sc. В & В '03'В forВ Comm.

IfВ admitted, В IВ proposeВ toВ resideВ[PleaseВ tickВ (

)В inВ theВ appropriateВ box)

MILВ (В В В В В В В В В В В В )

Elective(2) Elective(3)

1 3

InВ collegeВ hostel WithВ parents

a couple of 4

WithВ localВ guardian InВ privateВ accommodation

4thВ ElectiveВ inВ orderВ ofВ preference 1 two 3

CollegeВ Code CollegeВ Name OptionВ­03...



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