Common Application Form
B.Ed, B.H.Ed,M.Ed Courses
Higher Education Department, Odisha, Bhubaneswar
25TE020748692
Sunday, April 6, 2025, 04:30 PM
16:31:1
Candidate Personal Details
Photo
Course : B.Ed
Applicant's Type : FRESH
Applicant's Name : BIMALA BEHERA
Mother's Name : HIRA BEHERA
Father's Name : HATIA BEHERA
Gender : FEMALE Date of Birth : 05-MAR-1999
Email : BIMALABEHERA85@GMAIL.COM
Aadhaar No : XXXXXXXX4210
APAAR ID : NA
Signature
Mobile No. : 7656896384 Whatsapp No. : 7656896384
Alternate Mobile No : 9437422549
Marital Status : UNMARRIED Examination center : KEONJHAR(18)
Graduation : PASSED
Social Category : SEBC Reserve Category : PWD
Disability Category : PERMANENT
Caste certificate : NOT PROVIDED
Caste Issuing Authority : NOT PROVIDED Date of Caste Certificate Issuance: NOT PROVIDED
UDID Number : NA Scribe Required ? : NO Disability(%)
: 45
Type Of Disability : LOCOMOTOR DISABILITY
Locomotor Disability Type : OH
Have you studied Odia as a subject at HSC or equivalent Level or Higher or Passed Odia in the special Exam conducted by:
BSE Odisha of HSC Standard ?
YES
Opted for Hostel. : YES Green Passage Scheme : NO
Child without Biological Parents : NO Orphan : YES
HIV/AIDS-Affected Family (either father,
Single Mother Family : NO
mother or both) : NO
Staying at Child Care Institution : NO
Present Address
Address Line-1 : SUNDURIA Address Line-2 : TELKOI
Country : INDIA State : ODISHA
District : KEONJHAR Pincode : 758076
Block : TELKOI
Permanent Address
Address Line-1 : SUNDURIA Address Line-2 : TELKOI
Country : INDIA State : ODISHA
District : KEONJHAR Pincode : 758076
Residence Certificate NOT PROVIDED
Block : TELKOI Barcode :
Date of Residence
Residence Issuing Authority : NOT PROVIDED NOT PROVIDED
Certificate Issuance :
Income details of Parents
Father's Occupation CULTIVATION Mother's Occupation HOME MAKER
: :
Annual Income of the
0-1,50,000 Actual Annual Income (In Rs) 35000
parents(together) in Rs.
:
:
Income Certificate Barcode
NOT PROVIDED To Whom the Certificate is
Issued NOT PROVIDED
:
:
Date of Income Certificate
Income Issuing Authority NOT PROVIDED NOT PROVIDED
Issuance
:
:
Stream
Stream Name ARTS/COMMERCE
Educational Qualification
Mark Maximum Mark
Examination Passed University Year Of Passing RollNo Percentage
Type Mark Obtained
Graduation Other (North orisha university) 2019 1413K16002 CGPA 10.00 5.64 51.40
Bank Account Details
Account Number 34344521996 Account Holder Name BIMALA BEHERA
: :
IFSC Code SBIN0009636 MICR Code
: :
Bank Name STATE BANK OF INDIA Branch Name AKUL
: :
Other Information
Special Category (For GSSY
NONE OF THESE CM-KISSAN Scheme NO
Scholarship)
:
Nirmana Sramika Kalyan :
Yojanas
NO
:
Scholarship
*Based on the given information, You may like to apply for the scholarship schemes and check your eligibility. Please register at Scholarship Portal to apply different scholarships.
Note: Please refer to the respective scholarship guidelines and datelines for more information.
SL# Department Name Scholarship Scheme
1 ST&SC AND MBC WELFARE DEPARTMENT POST MATRIC SCHOLARSHIP
Declaration :
I BIMALA BEHERA do hereby declare that all the information furnished by me in this application form is true and complete to the best of my knowledge and belief. I
understand that entries made by me in this application form are final binding on me.
Place: Date: Signature of the candidate:
25TE020748692
