Application Form
Application Form
Application Form
Candidate Name : __________________________________________
Mother's Name : __________________________________________
Father’s Name : ___________________________________________
Guardian’s Name : ___________________________________________
Admission Class : ______________________ Class VI/ Class VII/ Class VIII/ Class IX
Date of Birth : ___________________________________________
Age on 31/03/2022 : __________________________________________
Gender : _________________________________________
Caste : _________________________________________
Religion : _________________________________________
Nationality : _________________________________________
Aadhar No of the Candidate : ___________________
Aadhar No of the Father : ____________________
Aadhar No of the Mother : _____________________
Aadhar No of the Guardian : ____________________
Whether Coming under PWD Category : Yes/ No________________
Type of Disability : __________________________ Attach Disability Certificate
a) Blindness & low vision
b) Deaf & hard of hearing
c) Locomotors disability including Cerebral Palsy,
Leprosy cured, dwarfism, acid attack victims and
Muscular dystrophy
d) Autism, intellectual disability, specific learning disability
And mental illness.
e) Multiple disability from amongst persons under clauses
(a) To (d) including deaf‐ blindness
Disability % : __________________________
Whether the candidate is a ward of OAV Employee Yes/ No Attach certificate from OAVS Office
(Out source employee to be excluded)
Whether the candidates is a ward of Yes/ No Attach certificate from State Govt Office
State Govt. / State PSUs Employee
Whether the candidate is suffering from Yes/ No
any chronic/ serious disease
Nature of the disease : _________________________
Category of school in which reading : Govt/ Aided/ Un‐aided recognised/ Others
(Attach Certificate from the concerned
DEO mentioning the category of the school)
Whether the school has got Yes/ No
COR from the Govt of Odisha
(Attached the photocopy of COR from
the Head of the Institution)
Name of the district in which school is situated : ________________________
Attach the certificate regarding bonafide student of the school
from the Head of the Institutions (As per format annexed)
Contact No of the Parent(s) : ________________________
E‐mail Id of the Parent(s) : _______________________
Permanent address
Village/ Town Situated in : ________________________
DISTRICT : ________________________
School Situated in : ________________________
Name of the Block/NAC/ Muncipality/ Municipal Corporation: ________________________
PINCODE : ________________________
OAV Name : ________________________
Present address
Village/ Town Situated in : ________________________
DISTRICT : ________________________
School Situated in : ________________________
Name of the Block/NAC/ Muncipality/ Municipal Corporation: ________________________
PINCODE : ________________________
(Attach Residence Certificate)
You are eligible to get admitted to : ________________________
OAV in case Entered
Bank accounts detail of the Parent/ Guardian
Name of the Bank :_______________________________
Account No : ______________________________
IFSC Code : _______________________________
Annual Income of the Parent :_______________________________
Paste photograph of the candidates Signature of the candidates
Parents declaration : ____________________________________________
1. I do hereby certify that the above information is correct to the best of our
knowledge and belief. If any information is found fake/ forged, the admission of our
child may stand cancelled.
2. I am seeking admission to OAV_________________ for my ward and have not
applied for taking admission into any other OAV. In case it is found that I have
applied for admission into more than one OAV, I undertake that the candidature/
admission of my ward shall be cancelled.
3. I do undertake that, my ward and we shall abide by the rules and regulations laid
down by Odisha Adarsha Vidyalaya Sangathan(OAVS), Bhubaneswar from time to
time.
4. I do understand that, the decision of the empowered committee of OAVS is final
and binding on us regarding admission.