ANNEXURE-1

NOMINATION/APPLICATION OF NAMES FOR STATE AWARD TO TEACHERS

1. Year of Award : 2017
2. Inclusion category (Elementary/Secondary/OAV/
DIET-BITE/Tol/Madrasa/HS-Arts/HS-Sc/HS-Com etc.
3. Name of the Teacher : LAXMI KANTA DAS
4. Date of Birth : 03.04.1963
(Third April Nineteen Hundred
Sixty Three)
5. Father’s Name : LATE JAYARAM DAS
6. Qualification : H.SC-C.T.
7. Post held in the school : ASST. TEACHER
8. Date of entry into service as a teacher : 13.07.1988
9. Present School Address with PS name : DESHABANDHU NODAL U.P. SCHOOL
AT/PO- ASURALI, PS- DHUSURI
DIST- BHADRAK, PIN- 756137
10. Permanent Address of Nativity with PS name: AT/PO- ASURALI, PS- DHUSURI
DIST- BHADRAK, PIN- 756137
11. Contact Email address of the teacher :
12. Contact Mobile No. : 9437709795
13. Write 2/3 sentences as to why the name should be considered:

Mr. Laxmikanta Das, Asst. Teacher Deshabandhu Nodal U.P. School, Asurali, Dhamnagar Block has served 29
years in Elementary Edn. Odisha Sri Das has devoted his career for academic excellence and all round
development of in school. Though his scholastic and non-scholastic activities in teachership is remarkable , so
he is working for consideration of STATE AWARD.

14. Name of previous schools if anywhere worked earlier in last 10 years:

Sl.
Name of the School & Block From To
No.
1 PATRI SAHI PRY. SCHOOL 01.05.1996 29.06.2003
2 DESHABANDHU NODAL U.P. SCHOOL 29.06.2003 25.06.2012
3 MANGALPUR PRY. SCHOOL 25.06.2012 01.09.2014
4 DESHABANDHU NODAL U.P. SCHOOL 01.09.2014 TILL DATE

Full Signature of the

authority who nominates with seal
or Applicant