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| 1. |
Name of the Applicant |
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| 2. |
Caste / Tribe Type |
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| 3. |
Native Village / Mandal |
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| 4. |
Distance to Hostel from Native Place |
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| 5. |
Date of Birth as per school records |
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| 6. |
Father's Name, Address, Occupation |
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| 7. |
Annual income details of father
(a) In case of Guardian, Guardian's address
(b) Guardian's Name and Annual Income |
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| 8. |
Name of the School which he is studying |
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| 9. |
Class in which student is studying at present |
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| 10. |
Whether the applicant has resided in hostel before? If yes please give details of hostel & year |
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| Signature of the Applicant |
Signature of the Head Master of the School with Seal |
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