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Application for e-BRAINS

[ecatrit - Bright RITian Alumni Initiative Scholarship]


(See “Information for Applicants” for details and instructions.)
Name of applicant Date of Birth:
[In BLOCK letters] (dd/mm/yyyy)
Present Address: Permanent Address:

Email:
Mob: Telephone:
Academic Data (Attach certified copies of mark sheets and / or rank certificate)
Name of Institution Date Passed % Marks
SSLC /
CBSE /
ICSE

Plus-2:

Engineering Entrance Examination Score/Rank:


Coaching for Entrance Exam (if any): No. of attempts in Entrance Exam:
Awards and Honors (Attached Certified copies):
1. 3.

2. 4.

Father’s Name: Mother's Name:


Occupation: Occupation:
Employer: Employer:
Annual Income: Annual Income:
Number of dependent children in the family:
Total Household Annual Income: (Include income from businesses, property, bonuses etc.)

College/tuition fees you need to pay- Per semester: Total for 4 years:
Hostel/boarding fees you need to pay- Per semester: Total for 4 years:
Extra-curricular activities (Give details / attach copies of certificates)

Declaration:
I solemnly swear that the information furnished by me in this application is completely true and correct. I understand that
falsification of information will result in immediate termination of scholarship and require refund of all amounts received.
I also express my unconditional consent to be a donor to this scholarship program once I am financially independent.
Signature of applicant: Date:

Signature and seal of Head of Department