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CommonApplicationForm

forAdmissiontoHigherSecondaryClasses
DepartmentofHigherEducation,GovernmentofOrissa

Forofficeuseonly MoneyReceiptcumIndexNumber

(MainForm)
TheapplicationformshouldbefilledinCAPITALLETTERonly. 1 NameoftheBoardfromwhichyouhavepassedthe
10th,Year&ExaminationRollNumber(Asinadmitcard)
Board/ State Yearof Passing 10thBoard RollNo.

Totalno.ofchoicesyouhave opted(Main&Addl.Form)

Thisapplicationformisvalidforadmissionto60JuniorColleges s(i.e.51GovernmentJuniorColleges&9LeadAidedJuniorColleges)

Fullnameof 3 theapplicant 4 Father'sName Affixyourself attested(onthe front)recent colour passportsize photographshere

5 Mother'sName (Ifparentsarenotalivepleasegiveguardian'sname&address) 6 AddressforCorrespondence a. HouseNo. b. Street/Village c. PostOffice e. PoliceStn. g. State i. Telephone(withSTDCode) ( ) j. Mobile(forSMSService) j k. eMailAddress 7 PermanentAddress(Itmaynotbefilledup,ifPermanentAddressissameasCorrespondenceAddress) a. HouseNo. b. Street/Village c. PostOffice e. PoliceStn. g. State i. Telephone(withSTDCode) 8 PersonalDetails a. BloodGroup b. Sex c. Religion d. DOB D D / M M / Y Y Y Y
For8(c)code,i.e.Religion,pleaserefertoInstructionManual

d. Block/ULB f. District h. PINCode

d. Block/ULB f. District h. PINCode

e. Category[Puttick(D)belowthecategoryapplicableinthebox]
e(1)

Reservation SC ST PH/OH ESM SDP CoM

e(2)

Weightage ScoutGuide PR RP Sports S N IN

NCC A C

f. WhetheryouareanOutsideStateApplicant(OSA)?(Y/N) g WhetheryouareanOriyaLivinginNeighbouringState(OLNS)?(Y/N) h. Areyouemployed?(Y/N) 9 Nationality 11 Father'sOccupation 13 AnnualIncomeoftheParents(Together)in Rupees


Ifyes,thenpleasegiveNOC/IncomeCertificatefromtheorganistaionwhereyouareengaged.

10 MotherTongue 12 Mother'sOccupation

14 Haveyoupassed10thBoardExaminationalCompartmentally?(Y/N)

e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

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15 Marksecuredineachsubjectin10thBoardExamination FL SL TL Math Science SocialStudies FL: FirstLanguage, SL: SecondLanguage, TL: ThirdLanguage 16 Recordofeducationalinstitutionlastattended NameoftheInstitution/School

TotalMarkSecured

MaximumMark

Location

DistrictName

Yearof Joining

Yearof Leaving

17 Ifyouarenotafreshcandidate,pleaseputtick( D)intheappropriatebox

Detained

Discontinued

Thisapplicationformisvalidforadmissionto60JuniorColleges s(i.e.51GovernmentJuniorColleges&9LeadAidedJuniorColleges)

PutCollege&Streamcodesaccordingtoavailabilityinrespectivecollegesinorderofpreference. 18 ForMIL(Compulsory)&ElectivespleaseusecodefromitemNo.3ofInstructionManual(AnnexureV).UseAdditionalFormfor
morethan13options.

CollegeCode CollegeName Option01 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option0 02 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option03 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option04 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

2 of 11

CollegeCode CollegeName Option05 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation
Thisapplicationformisvalidforadmissionto60JuniorColleges s(i.e.51GovernmentJuniorColleges&9LeadAidedJuniorColleges)

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option06 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option n07 SubjectCombination


C l Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL ( MIL() )
Elective(2) Elective(3)

1 3

Incollegehostel I ll h t l Withparents

2 4

With l l di Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option08 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option09 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

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CollegeCode CollegeName Option10 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation
Thisapplicationformisvalidforadmissionto60JuniorColleges es(i.e.51GovernmentJuniorColleges&9LeadAidedJuniorColleges)

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option11 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option12 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents With t

2 4

Withlocalguardian Inprivateaccommodation I i t d ti

4thElectiveinorderofpreference 1 2 3

CollegeCode CollegeName Option13 SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

UNDERTAKING I do hereby agree to abide by the rules of College/Hostel. I undertake that should any indiscipline and disobedience instance of the rules laid down by the Government or any authority empowered by them in this regard or should any conduct in the college is found not satisfactory, my name will automatically be removed from the college. I undertake that information furnished by me in this application is true and correct and I undertake that any wrong information furnished byme,detectedafterwardswillbetreatedascognizableoffence. I further undertake that I will not involve in any ragging activities in the College and hostel premises. I understand that criminalcasewillbefiledagainstmeifIindulgeinragging. Iherebyfullyendorsetheundertakingmadebyour child/ward Signatureorthumbimpressionofparents/guardian Place Date Submittedbyme

FullSignatureofApplicant Place Date

e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

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MoneyReceiptcumIndexNo.
CollegeCode Option(_______) CollegeName SubjectCombination
Compulsory
Elective(1)

(AdditionalForm)
StreamCode
Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode Option(_______) CollegeName SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode Option(_______) CollegeName SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference 1 2 3

CollegeCode Option(_______) CollegeName SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference

CollegeCode Option(_______) CollegeName SubjectCombination


Compulsory
Elective(1)

StreamCode

Use'01'forArts,'02'forSc.&'03'forComm.

Ifadmitted,Iproposetoreside[Pleasetick(D)intheappropriatebox)

MIL()
Elective(2) Elective(3)

1 3

Incollegehostel Withparents

2 4

Withlocalguardian Inprivateaccommodation

4thElectiveinorderofpreference

Signatureorthumbimpressionofparents/guardian Date Place

FullSignatureofApplicant Date Place

e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

5 of 11

CommonProspectus eCollege|SAMS|eAdmission

AnnexureI(ListofCollegeswithcodesandStreamwiseStudentStrength)

College Code SL# 1 1041101 2 2111101 3 2111202 4 3071101 5 4091101 6 5071101 7 5071102 8 5071203 9 5181201 10 6042101 11 7101101 12 7181101 13 7181202 14 8042101 15 9041101 16 9041202 17 10071101 18 10091101 19 11071101 20 11071102 21 11071203 22 11111201 23 11321101 24 12092101 25 13111101 26 14082101 27 15081101 28 15081202 29 16141101 30 16141202 31 17102102 32 18171101 33 18171202 34 19051101 35 19051102 36 19051203 37 19056169 38 20061101 39 20061202 40 20171101 41 20171202 42 21091101 43 22071101 44 22191101 45 23052101 46 24102101 47 25041101 48 26151101 49 26151202 50 27142101 51 28111101 52 28141101 53 28141202 54 29082101 55 30101101 56 30101102 57 30101203 58 30141101 59 30211101 60 30211202 District Name Angul Balasore Balasore Baragarh Bhadrak Bolangir Bolangir Bolangir Bolangir Boudh Cuttack Cuttack Cuttack Deogarh Dhenkanal Dhenkanal Gajapati Gajapati Ganjam Ganjam Ganjam Ganjam Ganjam Jagatsinghpur Jajpur Jharsuguda Kalahandi Kalahandi Kandhamal Kandhamal Kendrapara Keonjhar Keonjhar Khurdha Khurdha Khurdha Khurdha Koraput Koraput Koraput Koraput Malkanagiri Mayurbhanj Mayurbhanj Nawarangpur Nayagarh Nuapada Puri Puri Rayagada Sambalpur Sambalpur Sambalpur Sonepur Sundargarh Sundargarh Sundargarh Sundargarh Sundargarh Sundargarh NameofCollege Govt.JuniorCollege,Angul FakirMohanJuniorCollege,Balasore K.K.SWomen'sJuniorCollege,Balasore PanchayatJuniorCollege,Bargarh BhadrakJuniorCollege,Bhadrak Govt.JuniorCollege,Bolangir RajendraJuniorCollege,Bolangir Govt.WomensJuniorCollege,Bolangir Govt.WomensJuniorCollege,Titilagarh,Bolangir BoudhPanchayatJuniorCollege,Boudh J.K.B.KJuniorGovt.College,Cuttack RavenshawJuniorCollege,Cuttack ShailabalaWomen'sJuniorCollege,Cuttack DeogarhJuniorCollege,Deogarh DhenkanalJuniorCollege,Dhenkanal DhenkanalWomen'sJuniorCollege,Dhenkanal Govt.JuniorScienceCollege,Jirnaga,Gajapti S.K.C.GJuniorCollege,Paralakhemundi BinayakAcharyaJuniorCollege,Berhampur KhallikoteJuniorCollege,Berhampur S.B.R.Govt.JuniorWomen'sCollege,Berhampur NiranjanGovt.WomensJuniorCollege,Aska Govt.JuniorCollege,Chhatrapur S.V.MJuniorCollege,Jagatsinghpur NarasinghChoudhuryJuniorCollege,Jajpur LaxmiNarayanCollege,Jharsuguda Govt.JuniorCollege,Bhawanipatna Govt.WomensJuniorCollege,Bhawanipatna Govt.JuniorCollege,Phulbani S.MGovt.Women'sJuniorCollege,Phulbani KendraparaJuniorCollege,Kendrapara DharanidharJuniorCollege,Keonjhar Govt.Women'sJuniorCollege,Keonjhar B.J.BJuniorCollege,Bhubaneswar RajdhaniJuniorCollege,Bhubaneswar R.DWomen'sJuniorCollege,Bhubaneswar CollegeofBasicScience&Humanities,Bhubaneswar VikramDebJuniorCollege,Jeypore Govt.JuniorWomen'sCollege,Jeypore D.A.V.JuniorCollege,Landiguda,Koraput Govt.Women'sJuniorCollege,Koraput Govt.JuniorScienceCollege,Malkanagiri Govt.JuniorScienceCollege,Tiringi,Mayurbhanj MaharajaPurnaChandraJuniorCollege,Baripada NabarangpurJuniorCollege,Nawarangpur NayagarhJuniorCollege,Nayagarh Govt.JuniorScienceCollege,Nuapada SamantaChandraSekharJuniorCollege,Puri Govt.Women'sJuniorCollege,Puri RayagadaJuniorCollege,Rayagada N.S.C.BJuniorCollege,Sambalpur GangadharMeherJuniorCollege,Sambalpur Govt.WomensJuniorCollege,Sambalpur SonepurJuniorCollege,Sonepur Govt.JuniorCollege,Rourkela RourkelaJuniorCollege,Rourkela SushilabatiGovt.JuniorWomensCollege,Rourkela Govt.JuniorScienceCollege,Kutra,Sundergarh Govt.JuniorCollege,Sundargarh Govt.WomensJuniorCollege,Sundargarh Streamwise SanctionStrength Arts Sc. Com. 256 256 256 384 448 320 160 128 NIL 256 192 128 512 384 256 128 NIL NIL 256 256 128 256 NIL NIL 128 NIL NIL 192 64 NIL 160 256 NIL 512 384 256 256 256 NIL 192 128 NIL 256 256 128 128 128 NIL NIL 128 NIL 192 160 80 192 128 96 432 384 256 256 128 NIL 128 NIL NIL 128 128 64 384 256 256 256 256 128 64 128 128 384 256 128 128 NIL NIL 368 128 32 128 NIL NIL 256 384 224 192 256 96 128 64 NIL 512 544 128 256 384 NIL 512 384 256 NIL 384 NIL 256 256 256 192 NIL NIL 160 128 80 128 NIL NIL NIL 128 NIL NIL 128 NIL 576 256 192 192 192 64 384 384 128 NIL 128 NIL 512 352 160 176 NIL NIL 128 128 128 160 128 128 512 288 320 224 160 NIL 256 112 NIL 164 320 128 256 NIL 128 432 256 NIL NIL 128 NIL 256 256 128 256 128 NIL

e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

6 of 11

CommonProspectus eCollege|SAMS|eAdmission

AnnexureII(SampleCopyofIntimationLetter)


IftheAppliedCollegeisthesameastheDestinationCollegethentheIntimationisforFINALAdmission IftheAppliedCollegeisdifferentthanDestinationCollegethentheIntimationisforPRILIMINARYAdmission To (NameoftheStudent) (Father'sName) (AddressofCorrespondence) Congratulations!!! Youhavebeenselected/inwaitinglistforadmissionintohighersecondaryclassesasperfollowingdetails.

IntimationLetter
forAdmissiontoHigherSecondaryClasses DepartmentofHigherEducation,GovernmentofOrissa

MoneyReceiptcumIndex Number

(FirstSelection)

YourChoice/s inCAF Option04

ConfirmedInformation
Sl# 1 CollegeName GovernmentWomensJuniorCollege,Titilagarh,Bolangir Stream Arts 4th Elective I.T. Hostel Status Waiting8

WaitingInformationforhigheroptions.
Sl# 1 2 3 CollegeName JatiyaKabiBiraKishoreJuniorGovernmentCollege,Cuttack GovernmentJuniorCollege,Chhatrapur SashiBhusanRathGovernmentJuniorWomen'sCollege,Berhampur Stream Arts Science Science Waiting Rank 12 24 21

YourChoice/s inCAF Option01 Option02 Option03

Youarerequestedtoreporttotheprincipal (NameofthecollegewhereCAFsubmitted) withfollowingdocumentsinoriginalonorbefore (Date&Time) 1 (a) BankDraftofRs.500/drawninfavourof"ThePrincipal(DestinationCollege)"forPreliminaryAdmission 2 3 4 5 6 7 9 10 11 12 13 14 (b)

Cash/Bank Draft for total fees required for admission mentioned against each college in Common Prospectus for 'FinalAdmission'(i.e.ifyouhavebeenselectedforadmissionintheAppliedCollege)

OriginalBoardCertificateofHSCorequivalentOROriginalBoardMarkSheetcumProvisionalCertificateofHSCor equivalentasthecasemaybe. OriginalSchoolLeavingCertificate(SLC)/CollegeLeavingCertificate(CLC) OriginalConductCertificatefromtheinstitutionlastattended OriginalScheduleCaste/TribeCertificatefromrevenueofficernotbelowrankofTahasildar OriginalPH/OHCertificatefromCDMOofDistrict/SDMOofSubDivision/CMOofCapitalHospital OriginalExServiceManCertificatefromZillaSainikBoard OriginalSDPCertificatefroServiceDefensePersonnelfromCompetentAuthorities. OriginalNCCCertificatefromthecompetentauthority OriginalMigrationCertificatefortheapplicantfromotherBoardsexceptBSE,Orissa OriginalPermanentResident/NativityCertificateforOSA/OLNSapplicants. OriginalSportsCertificate OriginalScout&GuideCertificate


ForanyclarificationcallusatTollFreeNo.:155335(Workingdaysfrom10:00AM05:00PM)

e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

7 of 11

CAF|InstructionManual

1.

1.1. 1.2. 1.3. 1.4. 1.5. 1.6.

Give the name of the Board & State (e.g. BSE, Orissa/CBSE, New Delhi/CHSE, New Delhi/BSE, Manipur, Etc) from which you have passed the 10th Board Examination along with the year of passing&rollnumberasintheboardexaminationadmitcard. Please mention total number of options you have given in both the main & additional form (if any). Applicant: Name of the Applicant should be filled in the box provided. Leave one box empty betweenFirstName,MiddleName&Surname. Fathers Name: Fathers name of the applicant should be filled in the box provided. Leave one boxemptybetweenFirstName,MiddleName&Surname. Mothers Name: Mothersnameoftheapplicantshouldbefilledintheboxprovided.Leaveone boxemptybetweenFirstName,MiddleName&Surname. AddressforCorrespondence Following are the key information to be filled, which will help us to communicate with you regardingIntimation&otherupdatesaboutCAF&eAdmissionSchedules&Process. HouseNo.,Street/Village,PostOffice,Block/ULB,PoliceStation,District,Stateshouldbefilledin theboxprovided PinCode Pin Code of the applicant should be filled in the appropriate box provided. This informationisveryvitalforsendingtheintimationletterbyRegisteredPost PhoneNo Phone No of the applicant should be filled in the box provided. Your phone will be usedforanyspecialinstructionduringtheshortlisting/admissionprocess MobileNo MobileNooftheapplicantshouldbefilledintheboxprovided.Yourmobilenumber willbeusedforSMSserviceforupdatedinformationabouttheSAMS eMailID emailIDoftheapplicantshouldbefilledintheboxprovided.Intimationandother informationwillbecommunicatedtoyouelectronically.Sopleaseensureproperand valid email address while filling up. If you provide the mobile number, you will be abletogetthelatestupdates&informationaboutSAMS(CAF)bySMS.

HowtofilluptheCommonApplicationForm(CAF)

1.7.

PermanentAddress HouseNo.,Street/Village,PostOffice,Block/ULB,PoliceStation,District,Stateshouldbefilledin theboxprovided PinCode Pin Code of the applicant should be filled in the appropriate box provided. This informationisveryvitalforsendingtheintimationletterbyRegisteredPost PhoneNo Phone No of the applicant should be filled in the box provided. Your phone will be usedforanyspecialinstructionduringtheshortlisting/admissionprocess.

1.8.

PersonalDetails 8(a) BloodGroup :BloodGroupoftheApplicantshouldbefilledintheboxprovided 8(b) Sex :Sexshouldbefilledintheboxprovided(e.g.M:Male&F:Female) 8(c) Religion :Usecodeat2.0ofInstructionManualtofillthebox. 8(d) DateofBirth :FillyourdateofbirthaspertheDD/MM/YYYYformat 8(e) Category 8(e1) Reservation:PutaTick(D)markintheboxtothecategory SC:ScheduleCaste,ST:ScheduleTribe PH/OH:PhysicalHandicapped/OrthopedicallyHandicapped,ESM:ExServiceMan, SDP: ServiceDefensePersonnel,CoM:ChildrenofMartyrs 8(e2) Weightage:PutaTick(D)markintheboxtothecategory NCC(A): For anybody who has NCC (A) Certificate, NCC(C): For anybody who has participated in National Level NCC Camp, Scout Guide(PR): Anybody has got Rajyapal Puraskar, Scout Guide(PR):AnybodyhasgotPresidentRecognition, Sports(S):Anybody has participated in State Level sports, Sports(N): Anybody has participated in National Levelsports,Sports(IN):AnybodyhasparticipatedinInternationalLevelsports. 8(f) If you are an Outside State Applicant (OSA), please write Y in the box provided, or else writeNinthebox. 8(g) If you are an Oriya Living in Neighbouring State (OLNS), please write Y in the box provided,orelsewriteNinthebox.
Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected. 8 of 11

e-College | SAMS | CAF

CAF|InstructionManual

1.9. 1.10. 1.11. 1.12. 1.13. 1.14. 1.15. 1.16. 1.17. 1.18.

8(h) Ifyouareemployed,pleasewriteYintheboxprovided,orelsewriteNinthebox. Nationality:Nationalityoftheapplicantshouldbefilledintheboxprovided MotherTongue:MotherTongueoftheapplicantshouldbefilledintheboxprovided. Fathers Occupation: If your father is working in any Government/Private Sector/PSU/NGO, pleasementionthedesignationandofficenamewithlocation Mothers Occupation: If your mother is working in any Government/Private Sector/PSU/NGO, pleasementionthedesignationandofficenamewithlocation. AnnualIncomeofParents:Pleasementiontheannualincomeofyourparentstogether. If you have passed the 10th Board Examination compartmentally, please write Y in the box provided,orelsewriteNinthebox. AcademicRecords(H.S.C./Equivalent):GiveinformationasperthetablegivenintheCAF. Record of educational institution last attended: Giveinformationasperthetablegiveninthe CAF. Ifyouarenotafreshcandidate,pleaseputtick( D)intheappropriatebox PutCollege&Streamoptionsinorderofpreference.UseAdditionalformifyouwanttoapplyfor morethan13(choices)options.PleaserefertoAnnexureIforindicatingthecollegecode.Please checktheStream&StudentStrengthin(AnnexureI)andSubjectCode&Hostelavailabilityofthe facilitiesinthatparticularcollegeintheCommonProspectusbeforechoosingtheoption. [For MIL & Electives use subject code given at 3.0 in the Instruction Manual. If you have chosen a facility without availability of the same in that particular college then this option will be treated as invalid.]

2.

Hindu01 Muslim02

ReligionCodetobeusedinCAFforitem8(c).
Christian03 Jain 04 Buddhist05 Parsi 06

Sikh 07 Others 08

3.

SubjectCodetobeusedinCAF
SubjectName Accountancy Anthropology Biology Biotechnology BusinessMathematics&Statistics(BMS) BusinessStudies&Management(BSM) Chemistry CommercialBanking&Insurance CommercialGeography&RuralDevelopment ComputerApplication ComputerScience Economics Education Electronics English EnvironmentalEducation Funda.ofCompanyAccounts(FCA)&Funda.ofManagementAccounting(FMA) FundamentalofEntrepreneurship(FOE)&CostAccounting Geography Geology History HomeScience IndustrialRelationandPersonalManagement InformationTechnology Language(Bengali) Language(Hindi) Language(Oriya) Code 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
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e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

CAF|InstructionManual

Language(Persian) Language(Sanskrit) Language(Telugu) Language(Urdu) Logic Mathematics MIL(Sanskrit) MIL(AlternativeEnglish) MIL(Bengali) MIL(Hindi) MIL(Oriya) MIL(Telugu) MIL(Urdu) Music(Indian) Physics PoliticalScience Psychology Salesmanship&BusinessEconomics Sociology Statistics Yoga

28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48

4.
4.1.

4.2.

CompulsorySubjectsforAllStreams English,MIL(Oriya/Hindi/Bengali/Telugu/Urdu/ Persian/Sanskrit/AlternativeEnglish), EnvironmentalEducation&Yoga Arts History, Political Science, Logic, Economics, Statistics, Mathematics, Sociology, Geography, Education,Anthropology,Psychology,HomeScience,IndustrialRelation&PersonalManagement, Music (India), Information Technology, Language (Oriya / Hindi / Bengali / Telugu / Urdu / Persian/Sanskrit).
CombinationRestrictionsin+2ArtsStream Astudentshalloptfourelectivesubjectswiththefollowingcombinationrestrictions. a. Morethanonelanguagesubjectisnotallowed(Oriya/HindiBengali/Telugu/Urdu/Persian/Sanskrit) b. Threepracticalsubjects(Education/HomeScience/Geography/Psychology)cannotbetakentogether. Logic&Geographycannotbetakentogether. c. d. Education,Psychology&Music(Indian)cannotbetakentogether.(Anyoneofthemcanbetaken) e. Anthropology,Sociology&Statisticscannotbetakentogether.(Anyoneofthemcanbetaken) f. Mathematics&HomeSciencecannotbetakentogether. g. OnlywomencandidatescanoptforHomeScience. Restcombinationsareallowed.

StreamWiseSubjectDetails

4.3.

Science 1st&2ndElectives:Physics,Chemistry 3rdElectives:Mathematics/Biology/Geology 4th Electives: Mathematics, Biology, Economics, Statistics, Geography, Geology, Electronics, ComputerScience,Biotechnology,InformationTechnology,LanguageSanskrit). Commerce 1stElective:Accountancy 2ndElective:BusinessStudies&Management(BSM) 3rdElective:BusinessMathematics&Statistics(BMS) 4th Electives:CommercialBanking&Insurance,FundamentalofEntrepreneurship(FOE)&Cost Accounting, Salesmanship & Business Economics, Fundamental of Company Accounts (FCA) &
Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected. 10 of 11

4.4.

e-College | SAMS | CAF

CAF|InstructionManual

Fundamental of Management Accounting (FMA), Commercial Geography & Rural Development, ComputerApplication,InformationTechnology.

NOTE: In the case of Arts stream, the elective subjects opted by the applicant can be accepted subject to availability of seats in concerned college.

5.
5.1. 5.2. 6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7. 6.8.

DosregardingfillingupofCAF

Incaseofdoubts,queriesregardingtheCAF,Admissionprocess,etcapplicantsmaycontactthe Principals/MemberofAdmissionCommitteeofthe60collegesasperAnnexureI. Pleasesticktothetimescheduleanddatelineswhicharetobefollowedrigorously.

6.

DonotsubmittheCAFatmorethanonecollegeotherwiseyourapplicationmayberejected. DonotsubmittheincompleteCAF. DonotoverwriteanyinformationintheCAF. DonotuseseparateCAFforeachstream/college.Ifyouwantgivemorechoicesthenpleaseuse additionalformandgiveyouroptionsinorderofpreference. DonotputtheCAFintoanenvelopewhilesubmittingbyhandatthecollegecounter. DonotattachanyAnnexureorProspectusalongwiththeCAFwhilesubmittingthesame. Do not attach any documents other than those listed in clause no. 5.6 of Common Prospectus whilesubmittingtheCAF. DonotforgettoreceivetheMoneyReceiptcumIndexNumberaftersubmittingtheCAF.

DontsregardingfillingupofCAF

7.
7.1. 7.2. 7.3. 7.4. 7.5. 7.6. 7.7. 7.8. 7.9. 7.10. 7.11. 7.12. 7.13. 7.14. 7.15. 7.16. 7.17.

GeneralInstructions
Applicants are requested to use the Money ReceiptcumIndex Number as reference for any queriesatCollege(Applied)/TollFreeNumber(155335)/Website:(www.dheorissa.in). English,EnvironmentalScience&Yogaiscompulsoryforallstreams.OnehastoputcodeforMIL inthesubjectfieldincompulsorycategoryfromitemNo.3ofthisCAFInstructionManual. TheCAFshouldbedulyfilledinlegiblyintheapplicantsownhandwriting. No. field of CAF should be left blank. NA should be written against the column/box not applicable. CAF to be completed in all respect and should be deposited By Hand at any the 60 colleges (AnnexureI). Other State Applicant (OSA) can send the CAF by post. The application should reach before the duedateline(9Jul09). Firstoptioninadditionalformwillbetreatedaspreferenceno.14andsoon. Please tag both the main, additional (if used) & other document (Item No. 5.6 in common prospectus)properlybeforesubmitting. OriginalMoneyReceiptcumIndexNumbershouldbeproducedatthetimeofadmission Reservation&weightageshallnotbeconsideredwithoutsupportingdocuments(inoriginal)at thetimeofadmission. Noseatsshallbekeptreservedforanycategorybeyondthenormaldateofadmission. Total number of seats filled up with weightage under NCC/Sports/Scout & Guide/NSS shall be limitedto10%ofsanctionedstrengthineachclass. InformationTechnology(IT)beingaselffinancedcourseinvolvesadditionalcost.Thecostvaries fromcollegetocollege. Certificates submitted in support of reservation and weightage will be sent IG, Crime Branch Cuttackortheappropriateauthorityforscrutinyifnecessary. Suppression of facts or submission of incorrect information by the applicant, if detected at the timeofadmission(PreliminaryorFinal)orthereafterwillrendertheselection/admissioninvalid andthematterwillbereportedtotheIG,CrimeBranch,Cuttackforcriminalproceeding. No certificate will be entertained after the submission of the CAF. An applicant who does not enclosecertifiedtruecopiesofcertificatesinsupportofreservationandweightagewiththeCAF willnotbeentitledfortheabovepurpose. After admitting all eligible applicants for the reserved categories, the balance of reserved seats shallbefilledupbycandidatesbelongingtogeneralcategory.

e-College | SAMS | CAF

Applicants applying in two or more Common Application Forms (CAF) are liable to be rejected.

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