s Directorate of Students’ Welfare Guru Gobind Singh Indraprastha University © _ sector-16 C, Dwarka, Delli-1 10078 Website: nttp://ipu.ac.in SIPU/DSW Notice 2016) Dated: 28.09.2016 ctor Students’ Welfare invites applications from the 1 year female students of 3 Arch programme for joining a programme run by Katalyst, Human Capital for third + life skill enhancement mentoring. technology support finaneial incentive, internship sce to girls from low income communities so that they excel demically and get better ral opportunities, (0% & above in class x: 80% & above in PCM in class XIL amily income of less than rupees 2.5 lakhs per annum. ole female students of the University (USS and alfiliated Institutes) may submit their sion under prescribed format in the officer of Director Students” Welfare latest by 6. The detailed activities of the programme of Kataylst is enclosed herewith (Prot. CS. Rai) Director, Students’ Welfare All Deans/Direetor, USS - with a request to circulate this circular to all students Controller of Finance AR to Vice Chancellor for information of the Hon’ble Vice ¢ hancellor SO to Pro-Vice Chancellor for information of the Pro Vice Chan © (AR to Rewistrar for information of the Registrar All F inanee Officers All Notice Boards Incharge. Server Room — with a request to upload the noties on the University websKatalyst is a unique program that supports meritorious girls to succeed in their education, get better career opportunities and become leaders, while developing skills that are important in both personal and professional life. The programme includes: Itis a four-year program (Support tll graduation) that would include: Training and Workshops on (but not limited to): © English Speaking and communication skills ‘0 Personality development © Professional skills such as Interview Skills etc. © Aptitude, logical reasoning etc. © Technical training ~ Programming languages, other Software helpful for Engineers One -on -one mentoring © Financial assistance ‘* Laptop at a subsidised cost ‘* Convention in Goa ‘* Industrial Visits / Corporate workshops ‘Medical insurance for setf and mother ‘ Assistance with intemship and preparation for jobs in reputable companies © The student must have scored at least 70% and above in class Xth ©The student must have scored at least 80% and above in PCM/PCB in class XIlth ¢ The household income of the student must be less than 2.5 lakhs per annum. Basic requirements of the programme '* Two interactions of one hour each with the mentor every month © Onan average 16 days of training per year '* Academic excellence For further details and enrolment forms, contact University DSW, Dwarka, or the person mentioned below Krithika Rao krithika@katalystindia.ora (M) +91 9999 254 801 (0) 011- 43493320 Visit us at www.katalystindia.orgNe J. Katalyst, UID: ce SATAN A DELANY EH SETTLES Annexure B: KATALYSTAPPLICATION FORM List of Documents required Name of the Student: Name of the College: ‘Stream: College Year: Copy of the Birth Certificate/Aadhar Card Self-attested copies of Mark sheets for Class X, Class XI and Diploma Engineering Father's and / or Mother's Employer's Certificate / Letter Salary Statement or Income certificate of the Father and/or Mother Rent receipts/ ownership papers of family house Bank Statement for last two years of father of the applicant [-] Copy of student's Bank detail form signed and stamp by Banker (Annexure A) | Statement of financial assistance availed (in college and / or foundation) College admission document or fee receipt ‘Short Essay on "What | aspire to do ...” (approximately 250 words) (Please tick in the above box, if the document has beenreceived) For Office use only Head Office:502 A, Aurus Chambers, S SAmrutwar Marg, Worli, Mumbai(TO BE FILLED BY STUDENT IN BLOCK LETTERS) A. PERSONAL DETAILS FULL NAME: DATE OF BIRTH: PHOTOGRAPH CASTE CATEGORY: PERMANENT ADDRESS: CURRENT ADDRESS, STUDENT'S MOBILE NUMBER: PARENT'S/GUARDIAN'S MOBILE: STUDENT'S EMAIL ADDRESS: STUDENT'S PAN CARD / AADHAR CARD NUMBER: STUDENT BANK DETAILS: ACCOUNT HOLDER'S NAME: BANK NAME & BRANCH: ACCOUNT NUMBER: IFSC CODE: EDUCATIONAL QUALIFICATION ACHIEVEMENTS ‘% MARKS BOARD MAIN SUBJECTS _| OBTAINED AWARDS: [DIPLOMA HOBBIES AND PERSONAL INTERESTS,B. FAMILY BACKGROUND FATHER'S NAME: DATE OF BIRTH: QUALIFICATION: OCCUPATION: NAME OF THE EMPLOYER: REFERENCES (from people known to your father): "4. NAME. CONTACT, 2. NAME. CONTACT, MOTHER'S NAME: DATE OF BIRTH: QUALIFICATION: OCCUPATION: NAME OF THE EMPLOYER: REFERENCES (from people known to your mother): 4, NAME: CONTACT: 2. NAME: CONTACT: SIBLINGINFORMATIOI NAME RELATIONSHIP [AGE | QUALIFICATION OCCUPATION REFERENCE FROM THE LOCALITY / COMMUNITY 1. NAME: CONTACT: 2. NAME: CONTACT:C. FINANCIAL DETAILS RATHER'S ANNUALINCOME MOTHER'S ANNUAL INCOME, DETAILS OF OTHER AID / LOAN AVAILED 1 2: + DOES YOUR FAMILY OWN ANY OF THE FOLLOWING: Agriculture Land: Yes/No If YES, Specify area Vehicle: Two / Four Wheeler If YES, Mention name & quantity RESIDENCE: OWNED RENTED D. ESTIMATEOF ANNUALEDUCATION EXPENSE: [TYPE AMOUNT COLLEGE TUITION FEES | COACHING CLASSES BOOKS AND MATERIALS HOSTEL FEES MESS FEES TOTA\ FINANCIAL SUPPORT RECEIVED: PARTICULARS AMOUNT SOURCE SCHOLARSHIP 7 SUBSIDY LOAN FOR STUDIES OTHER | certify that the information provided by me in this form is true, accurate and complete. ‘Student's signature: | (full name of parent) Date: Place: give full permission for (student name) to enroll in Katalyst program. | understand that, if accepted, my child must attend all Katalyst activities as organized Parent's signature: