Data Collection Form for Bangalar Uchchashiksha Portal
Student Details of
Basic Description
Description Data
Do you have Banglar Shiksha Student ID
(Yes/No)
Banglar Shiksha Student ID (If yes)
Student Name*
First Name
Middle Name
Last Name
DOB*
Gender*
Social Category*
(e.g. General/SC/ST/OBC-A/OBC-B)
Religion*
(e.g. Hinduism, Islam etc.)
Whether BPL (Yes/No)
Blood Group
Nationality*
Aadhaar No*
Mobile No*
Email ID*
Whether Student is Disable* (Yes/No)
Family Details
Description Data
Father's Name*
First Name
Middle Name
Last Name
Father's Mobile No
Father's Profession
Father's Educational Qualification
(e.g. - Below Secondary/Secondary/Higher
Secondary/Graduate/Hons Graduate/Post
Graduate/ M.Phil./Ph.D./Others)
Mother’s Name
First Name
Middle Name
Last Name
Mother’s Mobile No
Mother’s Profession
Mother’s Educational Qualification
(e.g. - Below Secondary/Secondary/Higher
Secondary/Graduate/Hons Graduate/Post
Graduate/M.Phil/Ph.D./Others)
Guardian’s Name*
First Name
Middle Name
Last Name
Relationship with Guardian
(e.g. Aunt/Brother/Brother-in-
law/Father/Father-in-law/Grand
Father/Grand
Mother/Husband/Mother/Mother-in-
law/Nephew/Niece/Others/Sister/Sister-
in-law/Uncle/Wife)
Guardian’s Mobile No*
Guardian’s Email ID
Student Annual Family Income
Address Details
Present Address
Description Data
Address Line*
Country*
State*
District*
Post Office*
Police Station*
Pin*
Permanent Address
Description Data
Address Line*
Country*
State*
District*
Post Office*
Police Station*
Pin*
Present Course of Study Details
Description Data
Program Level *
(e.g.
UG/PG/Diploma/Certificate/M.Phil./Ph.D/Post
Doctoral/Others)
For UG
Description Data
Program Category *
(e.g. – B.A./B.Sc./B.Tech. etc.)
Medium Of Instruction*
(e.g. - English/Hindi/Bengali/Urdu/Santali
etc.)
Admitted In Category*
(e.g. - Unreserved/SC/ST/OBC-A/OBC-B)
Admission Academic Session*
Pursuing Semester*
For PG
Description Data
Program Category *
(e.g. – M.A./M.Sc./M.Tech. etc.)
Medium Of Instruction*
(e.g. - English/Hindi/Bengali/Urdu/Santali
etc.)
Admitted In Category*
(e.g. - Unreserved/SC/ST/OBC-A/OBC-B)
Admission Academic Session*
Pursuing Semester*
For M.Phil.
Description Data
Program Category * M.Phil.
Medium Of Instruction*
(e.g. - English/Hindi/Bengali/Urdu/Santali
etc.)
Admitted In Category*
(e.g. - Unreserved/SC/ST/OBC-A/OBC-B)
Admission Academic Session*
Pursuing Semester*
For Ph.D.
Description Data
Program Category* Ph.D.
Whether in Sponsored Project* (Yes/No)
Sponsoring Agency Name
Project Title Name*
Supervisor Name
Stipend Amount* (Yearly)
Fellowship Start Date*
Admission Academic Session*
For Post-Doctoral
Description Data
Program Category * Post-Doctoral
Medium Of Instruction*
(e.g. - English/Hindi/Bengali/Urdu/Santali
etc.)
Admitted In Category*
(e.g. - Unreserved/SC/ST/OBC-A/OBC-B)
Admission Academic Session*
Pursuing Semester*
For Diploma
Description Data
Program Category *
(e.g. ANM,DCE, DCFS, DDT etc.)
Medium Of Instruction*
(e.g. - English/Hindi/Bengali/Urdu/Santali
etc.)
Admitted In Category*
(e.g. - Unreserved/SC/ST/OBC-A/OBC-B)
Admission Academic Session*
Pursuing Semester*
For Certificate
Description Data
Program Category *
(e.g.- ITI, ACAM, PGCCS, PGCDS etc.)
Medium Of Instruction*
(e.g. - English/Hindi/Bengali/Urdu/Santali
etc.)
Admitted In Category*
(e.g. - Unreserved/SC/ST/OBC-A/OBC-B)
Admission Academic Session*
Pursuing Semester*
Scholarship Details
Description Data
Whether applied for SVMCM for the
present course* (Yes/No)
Applied Academic Year*
SVMCM ID*
Application Type (Fresh/Renewal)
Date of application
Date of recommending the application
Whether scholarship has been approved
Description Data
Whether applied for K2 for the present
course* (Yes/No)
Applied Academic Year*
K2 ID*
Application Type (Fresh/Renewal)
Date of application
Date of recommending the application
Whether scholarship has been approved
Description Data
Whether applied for K3 for the present
course* (Yes/No)
Applied Academic Year*
K3 ID*
Application Type (Fresh/Renewal)
Date of application
Date of recommending the application
Whether scholarship has been approved
Description Data
Whether applied for Aikyasree for the
present course* (Yes/No)
Applied Academic Year*
Aikyasree ID*
Application Type (Fresh/Renewal)
Date of application
Date of recommending the application
Whether scholarship has been approved
Description Data
Whether applied for OASIS for the present
course* (Yes/No)
Applied Academic Year*
OASIS ID*
Application Type (Fresh/Renewal)
Date of application
Date of recommending the application
Whether scholarship has been approved
Description Data
Whether applied for other Scholarship for
the present course* (Yes/No)
Name of the Scholarship*
Applied Academic Year*
K2 ID*
Application Type (Fresh/Renewal)
Date of application
Date of recommending the application
Whether scholarship has been approved
Student Credit Card
Description Data
Whether applied for West Bengal Student
Credit Card ID for the present course
(Yes/No)
Student Credit Card ID*
Signature of the Student
