1Name in full (in Block letters)(a) Permanent AddressAtPOViaBlockSDistrict(b) Nationality(c) Male/Female(d) Married/Un-marriedName of father/guardian(a) Present AddressP.(b) Relationship with the Guardian2Achievement in the field of sports & games with year (brief account) 3Date of Birth (in Christian era)4Educational Qualification and other technical and Vocational Training if any (attested copies of marksheets and certificates should be attached in support of age, qualification and training etc.) APPLICATION FORM FOR IDENTITY CARD FOR SPORTS PERSON Sports & Youth Services DepartmentGovernment of Orissa Published on National Portal of India (india.gov.in) 5 7Whether the candidate belongs to ST/SC if so, attested copies of the certificate in its support should be attached, Give the details 8Postal address to which communication should be sent DateSignature of the Candidate/LTI with attestation from any Gazetted Officer or Panchayat Samiti Chairman or Local MLA NB: Please attach 3 copies of passport size photographs Whether the candidate has enjoyed any scholarship/stipend or any financial help from State/Central Government if so; give details 6 candidate has registered his name with any employment exchange if so. The No & Date and name of employment exchange should be indicated Published on National Portal of India (india.gov.in) 9 YESNO
