Sl.no	Name of the Artist	Name of the Father/Husband	Name of the Art Form	Name of the Art Form	BKSS Reg.No/Date	Date of copy enclosed	Gender	Present Address	Permanent Address	Education Qualifications(matric of Above copy enclosed)	Head of the Institution/Name of the Guru along with address & Mobile No.	Whether the institution Registered under SocityReg.Act 1860 Yes/No (Certificate Enclosed)	Head of the Institution/Name of the Guru along with address & Mobile No.	Role of self in the Art form	Monthly Income	Whether received any Scholarship/Naional Scholarship/Research Philoship (details of copy enclosed)	Received an assistance scholarship(Before/Now)	Present Profession	During of the Training	Training in which Organisation	Accredtion (if any) AIR/DD(If Yes, Certificate enclosed)	Mobile Number	Whether Awared District/State/National(Govt.Non Govt.)
1	Ramesh Chandra Prusty	Gokhei Prusty	Palakara	Palakara		01/01/1939	Male	Vill-Amrutamanohi, Po-Nikirai, Via-Indupur, PIN-754211	Vill-Amrutamanohi, Po-Nikirai, Via-Indupur, PIN-754211	10th
2	Nirupama Pratap	Sridhar Nayak	Pala	Pala		27/06/1971	Female	Vill-Patia, Surya Bihar, Po-KITT-Fashionist Store, Khorda	Vill-Kakatapur, Po-Badihi, Via-Badapada, 754245		Basudev Pani, Vill-Itakandia, Po-Balia		Basudev Pani, Vill-Itakandia, Po-Balia	Palia				Pala		Sukarpada			Yes
3	Madan Mohan Mohanty	Brajananda Mohanty	Palakara	Palakara		27/03/1945	Male	Vill-Badapada, Po-Badapada, Via-Patamundai, 754245	Vill-Badapada, Po-Badapada, Via-Patamundai, 754245	9th				Palia							Yes		Yes