SCHOLARSHIP FOR HIGHER EDUCATION

APPLICATION FORM

Application
Status:
Submitted
Advertisemen
t No: SHE-
2018
Application Ref. #:
DST/INSPIRE/02/2018/022136
IVR
No:
20180
00497
25

Personal Particulars
Salutation: Miss
First Name: Kadambini Middle Name: Last Name: Bhuyan
Date Of Birth: 4/15/2001 Gender: Female Father's Name/Male Guardian
Name: KISHORE
CHANDRA
BHUYAN
Mother's Name/Female
Guardian Name: DIPIKA BHUYAN
10th Class Certificate or Marksheet as Proof of Date of Birth: Attached Place of Birth: Rural
Below
Email Address: kadambinibhuyan01@gmail.com
Social Community: OBC
Differently Abled: No Other:

Enrollment Information (B.Sc. / Integrated M.Sc. Level)

Program Enrolled: BSc
Course Enrolled: Geology
Enrollment/Admission Year: 2018 Admission No: 21
State (In which college is located): ODISHA
University Type: University University Name: Utkal University
University Address:Vani Vihar BhubaneswarPIN: 751004
College Name: Udayanath College of Science & Technology Adaspur : Adaspur
District (In which college is located): Cuttack
Endorsement Certificate: Attached Below

Senior Secondary Performance Information (12th Standard)

Name of the Board: Council of Higher Secondary Education, Odisha Bhubaneswar
Passing Year: 2018 Rank in Class 12th: Board Roll Number: 387EA090
Eligibility Note: Attached Below 12th Marksheet: Attached Below
Marks Information

Page 1/3
12/12/2018
16:40
 Subjects Marks ObtainedMaximum Marks Grade

ENGLISH 66 100 B

PHYSICS 74 100 B1

CHEMISTRY 79 100 B1

MATHEMATICS 61 100 B

BIOLOGY 80 100 A

SANSKRIT 78 100 B1

Other Subjects

Subjects Marks Obtained Maximum Marks Grade

SANSKRIT 78 100 B1

Total Marks Obtained: 438 Maximum Marks: 600 Overall Percentage(%): 73

School Name: SARASWATI VIDYAMANDIR NILAKANTHA NAGAR
BERHAMPUR
School Address: AT-BERHAMPUR, DIST-GANJAM
State (In which school is located): ODISHA
District (In which school is located): Ganjam
PinCode: 760001

National LevelCompetitive Examinations

Ra
nk
Examination Year Rank
Ce
rtif
ica
te/
Ce
rtif
ica
te

Other Details
Year of Passing Class X:2016 Parents Annual Income: 50000
Have you attended INSPIRE If Yes, please provide details. N/A
Science Camps:No

Contact Information
Permanent Address
Address: AT-SAHASPUR ,PO-NALIPUR
Town/City: Cuttack State: ODISHA Pincode: 754205
Telephone Number (with STD Mobile Number: 9937605638
code): N/A
Communication Address
Address: AT-SAHASPUR ,PO-NALIPUR
Town/City: Cuttack State: ODISHA Pincode: 754205
Telephone Number (with STD Mobile Number: 9937605638
code): N/A
Page 2/3 12/12/2018 16:4
Are you availing any other scholarships: N/A

Identification Proof : Aadhaar Card No :

Aadhaar Card 6605 8146 3190

Declaration: It is certified that all particulars given by me in columns above are

true to the best of my
knowledge. If any particulars are found false, I am aware that my application for
scholarship are liable for
cancellation.
Place: cuttack Submitted Date: 12/12/2018 State: ODISHA
Page 3/3 12/12/2018 16:4