The Godavari Sugar Mills’

Somaiya Grameen Vikas Kendra, Sameerwadi

Taluk : Mudhol Pin – 587 316 Dist : Bagalkot
Phone- (08350) 260046 / 47 / 48
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Application for Scholarship under a project Paste here a
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1. Name of the Student

(In capital letters)

2. Name of the course completed: 3. Name of the present course:

4. Name of your parent / guardian

5. Occupation of your parent / guardian Relation

6. Total annual income of the parent / guardian

7. Permanent Address: House No. Street Name / Location:

At / Post: Taluk: District:

Pin code: Phone No. with STD code

(Mention neighbor’s no. with their name if you do not have)
8. Name & Address of the School /
College in which he / she studied

At / Post: Taluk: District:

9. Details of marks obtained in

SSLC / II PUC / Degree Courses Total marks Percentage
(SSLC / II PUC / Degree) obtained of marks

10. Name & address of present college

At / Post: Taluk: District:

Signature of the student Signature with seal of

Present college Principal