APPLICATION FORM

ASIAN WORKERS DEVELOPMENT INSTITUTE (AWDI)

BASTIA SMRUTI SADAN,

SECTOR-6, ROURKELA-769002

  1. Application No. : ______
  1. Course Applied For : ______
  1. Hostel Accommodation Required (Y/N)
  1. Applicant’s Name : (In Block Letters)( Sur Name First)
  1. Sex (Male or Female): 8. Father’s/Husband’s name:

6. Present Address :

PIN
Ph. No.(code)
  1. Mother’s Name:
  1. Date of Birth:
  1. Nationality:

12. Category: (SC/ST/OBC)

PIN
Ph. No.(code)

7. Permanent Address : . 13. Others

Religion

Mother Tongue

Place of Birth

State of Birth

Blood Group

14. Email

  1. Academic Qualification:

Name of Exam / Name of Instn. / Name of Board
/University / Year / Division /
Class / % / Stream
1)Matriculation
or Class X
2)Plus Two (+2)
3)Degree(+3)
4)Post Graduation
(or degree if any)
  1. University Regd. Number

(For SambalpurUniversity Students)

  1. Details of Training/Work Experience(if any):

Name of Organisation / Nature of Job / Period
From / To
  1. Declaration by the Applicant:

I here by agree to abide the rules & regulations of the institution. I also here by declare that all statements made in this application are true, complete & correct to the best of my knowledge & belief. I undertake that , In the event of any information being found false or incorrect at any stage , my candidature is liable to be cancelled.

Place…………………

Date………………….SIGNATURE OF THE APPLICANT

DECLARATION (BY FATHER /MOTHER / LEGAL GUARDIAN)

I Sri/Smt. …………………………………………………………………………………………father / mother /

Legal guardian of ………………………………………………………………………………………..……..do

here by declare that I have read the rules and regulations of the institute and undertake that my son / daughter / ward shall abide by the same. I further declare that I shall remain responsible for the payment of all fees and charges payable by my son / daughter / ward. I shall also be responsible for good conduct & good behaviour of my son /daughter / ward during the period of his / her studentship in the institute.

I shall not claim or demand under any circumstances refund of the fees paid to the institute in connection with the admission of my son / daughter / ward.

Place …………………………..

Date…………………………… SIGNATURE