“Inspiring Pathways made it so much easier for us to find the right support for our child. Their resources are thoughtful, their team is kind, and the guidance we received was truly life-changing. We’re so grateful!”
Would like to thank Inspiring Pathways to give me the right guidance and connect me to the required Therapist in my city.
Dive into the stunning galaxy of EVE Online. Test your limits today. Explore alongside thousands of players worldwide. Join now
baklink certificate nhi ban raha hai please help me
I am looking for an Oppurtunity as a Senior Marketing Manager please cont me-7829460332
CHENGALPATTU MEDICAL COLLEGE HOSPITAL
Personal Details
Applicant’s Full Name*
SARADA PRASAD PRADHAN
Applicant Name in Tamil*
சாரதா பிரசாத் பிரதான்
Applicant Mobile No.*
7873817536
(mobile number can be used upto only four application)
Applicant Email Id
saradaprasadpradhan55@gmail.com
(email can be used upto only four application)
Applicant Date Of Birth *
19/07/8031
Gender :*
Male
Female
Transgender
Name of Applicants Father/Mother/Guardian *
Father
Applicant Father’s Name *
BANAMALI PRADHAN
Contact No. of Guardian / Caretaker *
8903534861
Photo *
100kb.jpg
(Only jpeg, jpg and png image with size 5 KB to 100 KB allowed and Photo image Width and Height less than 800px allowed)
NOTE :- Please upload a recent photograph.
Signature / Thumb / Other Print
No file chosen
(Only jpeg, jpg and png image with size 3 KB to 30 KB allowed)
Proof of Identity Card
Aadhaar Enrollment Number*
06541128403937
Upload Aadhaar Enrollment slip *
ADHAR ENROLLMENT CARD (2).jpg View (Only jpeg, jpg and png image with size 10 KB to 150 KB allowed)
Identity Proof *
Ration Card
Upload Identity Proof *
RASON CARD.jpg View (Only jpeg, jpg and png image with size 10 KB to 150 KB allowed)
Address for Correspondence
Nature of Document for Address Proof *
Aadhaar card
Proof of Correspondence Address*
ADHAR CARD TAMILNADU (1).jpg(Only jpeg, jpg and png image with size 10 KB to 150 KB allowed)
View
Address*
179,15th Avenue,dae Township, Kalpakkam
State / UTs*
Tamil Nadu
District *
Chengalpattu
City / Sub District / Tehsil *
Choose City / Sub District / Tehsil
Please select city / sub district / tehsil.
Village / Block
Choose Village / Block
Pincode *
603102
Disability Details (In Case of Multiple Disabilities, Please choose 2 or more out of the 20 disabilities)
Disability Type*
Locomotor Disability
Disability Due To
Diseases
Disability by Birth *
Yes
No
Disability Since*
1982
Hospital for assessment/issue of UDID card /disability certificate
Is your treating hospital in other State/District ? *
No
Yes
Hospital Name*
Select Hospital Name
Please select hospital name.
Captcha *
10 + 9
Sound Icon
19
I hereby declare that all particulars stated above are true to the best of my knowledge and belief, and no material information has been concealed or misstated. I further state that if any inaccuracy is detected in the application, I shall be liable to forfeiture of any benefits derived and other action as per law. *
I hereby provide free and unconditional consent under DPDP Act 2023 for ethical sharing of above details with any Central/State/UT Government and Departments for purpose of my skilling, awareness or similar benefit to me. I also understand that I can withdraw my consent any time on the portal from my Dashboard.(Optional)
Subm
