Application Form

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1. Personal Information: Your name Date Of Birth (DD/MM/YYYY): Age Gender Address City State Pin Code Mobile Number Your email

2. Educational Background: Highest Educational Qualification Name of Institution Year of Graduation Relevant Certifications (if any)

3. Disability Information (if applicable): Type of Disability Describe the Nature of Your Disability: Do you use any assistive technology? If yes, please specify: Are you able to participate in a 5-month residential program? Do you require any specific accommodations during the program? If yes, please provide details:

4. Personal Story & Background: Tell us about your journey and challenges. What has been your biggest motivation in life? (Please explain in 200 words) What is your dream or aspiration? How do you envision your future? (Please explain in 150 words) If you have worked before, tell us about your work experience. What kind of jobs have you done, and what did you learn? (If applicable, provide details about any work experience) If you have run a small business, describe your experience. What business did you run, and what were the challenges? (If applicable, provide details about your small business experience)

5. Financial Independence & Opportunity: If you haven't had the opportunity to work or start a business, how would you plan to develop yourself if given the chance? Do you believe a pension or external financial support is enough to sustain your life? Why or why not?

6. Understanding of the Disability Community: In your opinion, why do persons with disabilities continue to face challenges in India? What do you think are the biggest barriers? What is your understanding of the government schemes and NGO support available for persons with disabilities? Have you benefited from any government programs or NGO support in the past? If yes, what kind of support did you receive, and how did it help you?

7. General Knowledge & Awareness: What do you know about the current situation of persons with disabilities in your community? How do you think it can be improved? Have you ever participated in any training or skill development programs? If yes, how did they help you grow?

8. Commitment & Motivation: How do you stay motivated when faced with challenges? What keeps you going? If selected for the DE-Hub EDP program, how will you commit yourself to the 10-month journey towards achieving financial independence? If you have a business idea, briefly describe your business concept: What are the key challenges you anticipate facing as an entrepreneur?

9. Personal Undertaking: Parents/Guardian Undertaking (if applicable): "I, , fully support my child/ward's participation in the DE-Hub EDP program and commit to providing all necessary support during their entrepreneurial journey." Signature of Parent/Guardian: Date: Applicant Declaration: "I, , hereby confirm that all the information provided in this application form is true and accurate to the best of my knowledge. I understand the commitments required to participate in the DE-Hub EDP program and agree to abide by the terms and conditions of the program." Signature of Parent/Guardian: Date:

10. Additional Documents: Please attach copies of the following documents: Aadhar Card (or equivalent ID) Educational certificates (minimum Intermediate) Medical certificate (if applicable for PWD status) Proof of Address By submitting this application, you confirm that you have read and understood all the important points related to the DE-Hub EDP program.

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