BASIC INFORMATION FORM – STATE SCHOLARSHIP PORTAL Name (For only those who expects our paid service) IMPORTANT: Before filling this form, make sure that you have prepared all the required documents / information. ಈ ಅರ್ಜಿಯನ್ನು ತುಂಬಿಸುವ ಮೊದಲು, ಅಗತ್ಯ ದಾಖಲಾತಿಗಳನ್ನು / ಮಾಹಿತಿಯನ್ನು ನೀವು ಸಿದ್ಧಪಡಿಸಿ ಇಟ್ಟಿರುವಿರಿ ಎಂಬುವುದನ್ನು ಖಚಿತಪಡಿಸಿಕೊಳ್ಳಿ. TYPE ALL DETAILS IN: ENGLISH CAPITAL LETTERS BASIC DETAILS College Name & Address * Dr. Shivarama Karanth GFGC Bellare GFGC Bettampady GFGC Puttur (Jidekal) GFGC Sullia GFGC (Women) Puttur GFGC Uppinangady GFGC Vittal St. Philomena College, Puttur Vivekananda College, Puttur Vivekananda Engineering College Sahyadri College of Engineering Other - Not Listed Course Name * BA B.COM BBA BSc. Other Course Year * 1st Year 2nd Year 3rd Year 4th Year University Registration No * ಯೂನಿವರ್ಸಿಟಿ ನೋಂದಣಿ ಸಂಖ್ಯೆ I have Registration No I have UUCMS No Not Issued (Provide you later) Student Name (as in Aadhaar) * Aadhaar Number * Gender * ಲಿಂಗ Male Female Transgender SSLC / 10th Studied State * KARNATAKA ANDAMAN AND NICOBAR ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATTISGARH DADRA AND NAGAR HAVELI DAMAN AND DIU DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR JHARKHAND KERALA LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ODISHA PUDUCHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA UTTARAKHAND UTTAR PRADESH WEST BENGAL SSLC Board * ಪರೀಕ್ಷಾ ಮಂಡಳಿ State Board CBSE ICSE Any Other Date of Birth (as in SSLC) * SSLC Register No * SSLC Passing Year * ತೇರ್ಗಡೆ ವರ್ಷ 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Day Scholar or Hosteler? * ಹಾಸ್ಟೆಲ್ ನಿವಾಸಿಯೇ? Day Scholar Govt. Hosteler Private Hosteler Person with Disabilities? * ವಿಶೇಷ ಚೇತನರೇ? Yes No PARENT DETAILS Parent's Living Status * ಹೆತ್ತವರ ಬದುಕಿನ ಸ್ಥಿತಿ Both Father and Mother Alive Only Father Expired Only Mother Expired Both Father and Mother Expired RESERVATION DETAILS Religion * ಧರ್ಮ Hindu Muslim Christian Jain Sikh Parsis Distance From Home to College * Total College Fees (Tuition + Exam) * CONTACT DETAILS Email ID * Student Mobile No. * Parent's Phone Number * WhatsApp Number UPLOAD SECTION Upload Only PDF Files or JPG/JPEG Images ಕೇವಲ PDF ಫೈಲ್ ಅಥವಾ JPG/JPEG ಫೊಟೋಗಳನ್ನು ಅಪ್ಲೋಡ್ ಮಾಡಿ SSLC Mark Card * Student Aadhaar Card * College Fees Receipt * Declaration: I declare that all the information provided is correct & valid. I consent these information can be used for Scholarship Application submission purpose in SSP Portal. I agree to pay the required service charges to CRUST. Read Our Privacy Policy * ಸೂಚನೆ: ನೀವು FINAL SUBMIT ಕ್ಲಿಕ್ ಮಾಡಿದ ನಂತರ ದಾಖಲೆಗಳು ಅಪ್ಲೋಡ್ ಆಗುವ ತನಕ ದಯವಿಟ್ಟು ಕಾಯಿರಿ. ಫೈಲ್ ಸೈಜ್ ಹೆಚ್ಚಿದ್ದರೆ, ಅಪ್ಲೋಡ್ ಆಗಲು ಹೆಚ್ಚಿನ ಸಮಯ ತೆಗೆದುಕೊಳ್ಳುವುದು SUBMIT ಯಶಸ್ವಿಯಾದ ಕೂಡಲೇ TOKEN Number ಇದೇ ಪರದೆಯಲ್ಲಿ ಕಾಣಿಸಿಕೊಳ್ಳಲಿದೆ ಮತ್ತು ನಿಮ್ಮ ಇಮೇಲ್ ಇನ್‍ಬಾಕ್ಸ್ ಗೆ (ಅಥವಾ ಸ್ಪಾಮ್ ಫೋಲ್ಡರ್) ಕನ್ಫರ್ಮೇಶನ್ ಇಮೇಲ್ ಬಂದಿರುವುದನ್ನು ಪರಿಶೀಲಿಸಿ. ಕನ್ಫರ್ಮೇಶನ್ ಇಮೇಲ್ ಬಂದರೆ ಮಾತ್ರ ನಮಗೆ ನಿಮ್ಮ ಮಾಹಿತಿ ಲಭ್ಯವಾಗುತ್ತವೆ. Note: Once you click FINAL SUBMIT, please wait till all your documents to be uploaded to server. If file size is larger, it may take little longer time to upload. Once the submission completed you can see a TOKEN Number in this same screen and also you will receive an email confirmation with Token Number. Disclaimer: It's an exclusive form designed for internal purposes only. It is not an official web form nor replica of SSP Portal of Government of Karnataka. For official information, we recommend you to visit respective authority's official website.
