ONLINE REGISTRATION FOR MU HERO
Personal Information
(*) Indicates fields are mandatory
Nomination Type :
For Self
Other
First Name (ପ୍ରଥମ ନାମ)
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Middle Name (ମଧ୍ୟ ନାମ)
Last Name (ଶେଷ ନାମ)
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Address (ଠିକଣା)
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Mobile Number (ମୋବାଇଲ୍ ନମ୍ବର)
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Email Id (ଇମେଲ୍ ଆଇଡି)
Distict (ଜିଲ୍ଲା)
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--Select--
Angul
Balasore
Baragarh
Bhadrak
Bolangir
Boudh
Cuttack
Deogarh
Dhenkanal
Gajapati
Ganjam
Jagatsinghpur
Jajpur
Jharsuguda
Kalahandi
Kandhamal
Kendrapara
Keonjhar
Khurdha
Koraput
Malkangiri
Mayurbhanj
Nawarangpur
Nayagarh
Nuapada
Puri
Rayagada
Sambalpur
Sonepur
Sundergarh
Block/ULB (ବ୍ଲକ / ସହରାଞ୍ଚଳ)
*
Select
GP/Ward (ପଞ୍ଚାୟତ/ୱାର୍ଡ)
*
--Select--
Identity Proof (ପରିଚୟ ପତ୍ର)
*
--Select--
Aadhar Card
Pan Card
Other
Identity No (ପରିଚୟ ନମ୍ବର)
Gender (ଲିଙ୍ଗ)
*
--Select--
Male
Female
Transgender
Photo Upload
(Max 200KB allowed, Only jpeg, png allowed)
(ଫଟୋ ଅପଲୋଡ (୨୦୦ କେ.ବିରୁ ଅଧିକ ହୋଇପାରିବ ନାହିଁ, କେବଳ ଜେପିଇଜି ଏବଂ ପିଏନଜି))
Facebook Link (ଫେସବୁକ୍ ଲିଙ୍କ)
(E.g : https://www.facebook.com/user_name)
Twitter Link (ଟୁଇଟର ଲିଙ୍କ)
(E.g : https://www.twitter.com/user_name)
Date Of Birth (ଜନ୍ମ ତାରିଖ)
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DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
YYYY
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Educational Qualification(ଶିକ୍ଷାଗତ ଯୋଗ୍ୟତା)
--Select--
Matriculation
Intermediate
Graduate
Post Graduate
Any Other
Member of any Youth Agency (କୌଣସି ଯୁବ ସଂଗଠନର ସଦସ୍ୟ)
(You can select multiple choices)
BijuYuvaVahini
NSS
NYKS
NCC
Red Cross
Scout & Guides
CommunityBasedOrganisation
Any Other
About (ବିଷୟରେ)
(Maximum 1500 character)
Hero Achievement (ସଫଳତା ବିବରଣୀ)
Category (ବିଭାଗ)
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Achievment (ସଫଳତା)
*
Document
--Select--
Youth who have taken a leadership role, done exemplary work, influenced people bringing social transformation in the fields of Education,Health & Hygiene,Sanitation, Environment,Women Empowerment,Civic Sense,Breaking myths and social taboos/building scientific temperament
Youth who have taken initiative/leadership during any of the following Natural calamities (epidemics/flood/cyclone/or any other natural calamity),Crisis management and Social unrest – (worked towards communal harmony, mediated to resolve social unrest/brawls within the community),Act of bravery
Youth who have taken a leading role in pursuing/advocating education
Youth who have shown innate enterprise to create awareness and spearhead movements of community welfare
Youth who have set examples in the field of entrepreneurship, made innovations to ease the life of community at large
Youth who have excelled in sports, art & culture, literature and earned laurels at the state level & beyond
Youth who have been good Samaritans and helped people for medical treatment or during calamities
Youth who have taken special initiatives/efforts to initiate cleanliness drives, plantation drives or de addiction/anti drugs/alcohol abuse campaigns
Youth who have been change agents by publishing their radical and enlightening ideologies in larger public interest