Application for Scholarship

Higher Education Department, Government of Odisha

e-Medhabruti 2016 * Mark indicates mandatory field
Scholarship Type * :




Institute Type * : SAMS College    Non-SAMS College
District * :
Institute Name  * :
Stream  * :
Roll Number * : -
Date of Admission * :
State : Odisha    Other State District :
Institute Name  * :
Institute Address* : Institute Website (if any) :
Type of Course * : Duration of Course (in years) * :
Course Name* : Duration of Course (in years) * :
Entrance Name* : Rank* :
Institute Roll Number * : Date of Admission * :

Full name of the Applicant * : Gender * :
Date of Birth * : Religion * :
Nationality  * : Mother Toungue * :
Category * : PH/OH :
Mobile Number * : Aadhaar Number (Optional) :
Name Profession Annual Income (in Rs.)
Father / Guardian *
Mother *
State * : District * :
Block / ULB * : Address * :
PIN Code  :
Telephone Number : - e-Mail :
Name of the Examination * :
Name of Board / Council / University * :
Year of Passing * :
Type* :
Mark Secured * :
Maximum Mark * :
Beneficiary Name * :
Account Number * :
IFSC Number * :
(For online money transfer through RTGS/NEFT)
MICR Code :
Bank Details : * *
Helpline Toll Free Number :155335 / 18003456770