Application Form for Scholarship

FOR FOUNDATION USE ONLY

(Not to be filled in b the st!dent"
A##LI$ATION NO% Category Max.Limit No. of Scholarship
Ref& No& % Sanctioned so far
1. Name Mr./Miss.. 6. Amount of Scholarship s.. p.m.
! " !upees. per month"
#. Studying in $. %eriod of Scholarship years..months
&. 'uration of course . (ears
). Last exam. %assed ! *"
'& +amily ,ncome s p.a. (& )& *&
Sitaram +indal Fo!ndation Anne,!re II
(( -reen A.en!e/ 0hatta Road/ 0ehind Sector D1*/ 2asant 3!n4/ Ne5 Delhi 1 ((6 676
+indal Na8ar/ T!m9!r Road/ 0an8alore 1 ':667*
(to be filled in b the st!dent .er caref!ll"
%.-...
1" Name in +ull
!CA%,-AL L/--/S0 as per mar1sheet"

#" 'ate of 2irth 3 &" Nationality3 .

)" Addresses 4ith %in Code !a" %resent address and
-elephone No.
3 ..
..
..
!5" %ermanent address and
-elephone No.
3 ..
..
..
6" +ather7s/ 8uardian7s name 4ith phone num5er and
email0id
3 ..
6" Are you physically handicapped or 9ard/9ido4 of /x0
Ser:iceman !State Clearly"
3 ..
$" .ccupation of +ather/ 8uardian ; annual income of
entire family from all sources
3 ..
s... p.a.
<" %articulars of last examination passed
-otal mar1s ; %ercentage of mar1s o5tained
3
3
..
..*

=" Class/-rade in 4hich studying at present
9hether regular or part time or 5y correspondence
3 ..
!egular/ %art -ime/Correspondence"

1>" Name? address and e0mail id of School/ College/
,nstitute
3
3
.
.
11" 'uration of the Course 3 .. (ears
1#" Month ; (ear of +inal /xam of Course 3 . Month (ear
1&" -otal annual fees 3 s.. p.a.
1)" 9hether staying in @ostel !only ,-, ; College Students"
!,f yes? 4hat are the charges incurred per month"
3
3
(es/No
s.. p.m.
Affix Passport
Size Photograph
attested by the
Principal with
Seal
Doc!ments to be attached %
+or 2%L Students
!School 8irls" ; !College 2oys ; 8irls"
3 %hotocopy of 2%L Card duly attested 5y the %rincipal and copy ofMar1s Card of pre:ious
/xamination
+or ,-, students 3 ,n case student stays in hostel? su5mit payment receipts along4ith original @ostel Certificate/
Letter from 9arden duly attested 5y the @ead of the ,nstitution 4here studying.
+or College Students
!5oth graduate and post graduate"
3 1" %hotocopy of income certificate issued 5y competent authority duly attested 5y the %rincipal/
@ead as per ANN/AB/0,C.
#" %hotocopy of the mar1s sheet of class A? A,, and last Dualifying examination passed duly
attested 5y the %rincipal/ @ead.
&" ,n case student stays in hostel? su5mit payment receipts along4ith original @ostel Certificate/
Letter from 9arden duly attested 5y the @ead of the ,nstitution 4here studying.
Additional documents to 5e attached in case of 3
!i" 2%L student 3 %hotocopy of 2%L Card duly attested 5y the %rincipal/ @ead.
!ii" %hysically @andicapped Students 3 %hotocopy of the disa5ility certificate issued 5y the competent authority duly attested 5y the
%rincipal/ @ead.
!iii" 9ido4s and 4ards of /x0ser:icemen 3
!a" Attested photocopy of discharge 5oo1 and %%. of the ex0ser:iceman
!5" Attested copy of ex0ser:iceman/ 4ido4 identity card issued 5y aEya/ Fila Sani1 2oard
!c" Attested copy of relationship/ dependency certificate from .,C records.
%lease refer our 5ebsite 555&sr4f&or8 for list of ,-, trades? graduation ; post graduation courses eligi5le and other conditions 5efore filling up
the form.
(Attestation of the photo8raph b the #rincipal 5ith Seal is m!st"
#rincipal; <ead=s Report
,t is here5y certified that
a" the particulars gi:en 5y the student are correct as per the records of the School/ College/,nstitute.
5" the student 5ears a good moral character.
c" the student is/is not recei:ing financial assistance from any other source.
d" the student is/is not physically handicapped/disad:antaged.
e" our school/ institute/ college is 8o:t./ 8o:t. Aided or %ri:ate .. !State clearly"
f" our school/ institute/ college is affiliated to . 2oard/ Bni:ersity/Council
g" num5er of students in school !class ,A to A,,"/ institute/ college is ..Nos.
h" the foundation shall 5e informed? if the student lea:es studies.
,t is further recommended that the student may 5e a4arded a scholarship f s p.m. till
.. !State month ; year of last final exam of the course".
Si8nat!re of School; $olle8e; ITI #rincipal 5ith seal
Date %
16"
16"
Are you getting any stipend/ freeship/ scholarship
from any other source.
,f so mention source and amount.
@a:e you applied pre:iously to us for scholarship?
4hether it 4as sanctioned? if so? reference/file No.
3
3
..(es/No
s.. p.m.
(es/ No ef/ +ile No. ..
1$" Scholarship amount reDuired 3 s.. p.m.
1<" Name and location of 2an1 5ranch along 4ith full
details of the account of the Student.
3

, here5y certify that the information disclosed 5y me is true. , agree to a5ide 5y the -erms and Conditions of the
+oundation pre:ailing from time to time.

!Signature of +ather/ 8uardian"

!Signature of the Student"

%lace 3
'ate 3