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Vidya Poshak ®

Student Information Sheet 2018-19

((Please fill the details in capital letters)
Note:
 Please read instructions & eligibility criteria provided in the next page
carefully before filling the form. Photo
 Completed applications should reach Vidya Poshak by 15th of June2018
 Only students joining Commerce, Arts,Diploma,ITI,GTTC should apply
 Attach Xerox copy of marks card along with filled application without fail
 Please provide accurate and complete address in the application.

1. Student’s full name

2. Medium of instruction in High school : Kannada English Other specify

3. SSLC Hall Ticket Number

4. Marks & % secured in SSLC/CBSE : Marks: %

5. Parents’ Residential Address :

H.No: Street Name: Village Name:

Land Mark near your house: Po:

Tq: District: Pin:

Contact number 1) 2)

6. Parents’ Occupation :

7. Annual Income of Family (Rs) : `.

8. Preferred stream ( ) : Commerce Arts Education ITI

GTTC Diploma

I hereby declare that all the information given above is true to the best of my knowledge

Date: Signature of the Student

Place:
 Please read the following carefully before proceeding fill the form

 ELEGEBILITY TO APPLY
 Should have appeared for the SSLC examination for the first time in March/April, 2018
 The applicant should have scored at least 80% in the SSLC Karnataka board/CBSE
examination.

 Aspiring to join Commerce, Arts, Education in PUC 1st year & Diploma, ITI, GTTC
 Total family income should be less than Rs.80, 000 /- per annum (Rupees Eighty
Thousand only).
AND
 Parents of the applicant should be resident of one of the following districts of Karnataka
(Please note that applicants from only the taluks’ mentioned in the vidya Poshak website
are eligible to apply)
1) Dharwad 2) Gadag3) Davanagere 4) Belagavi 5) Uttar Kannada 6) Vijayapur 7)
Bagalkot 8) Shivamogga
 PROCEDURE TO APPLY FOR FINANCIAL ASSISTANCE
Applicants should download the application form from the Vidya Poshak website
(www.vidyaposhak.ngo) and fill in all the relevant information, attach supporting
document/s (Marks card copy) and post it to the nearest Vidya Poshak office. Application
forms are available in Vidya Poshak website www.vidyaposhak.ngo and at branch our
offices mentioned below
District/s Address
Dharwad and Vidya Poshak, Nagarkar Colony, Mahishi Road, Behind Sai Nursing
Gadag Home, Dharwad-580007,Email:info@vidyaposhak.org,
Website: www.vidyaposhak.ngo
Davanagere Vidya Poshak, Vaisya Hostel, Near Jayadeva Circle, Davanagere-577 002.
Ph 98443 39197
Belagavi Vidya Poshak, Shri Anand Doddanavar Memorial Library, 1st Floor,
Doddanavar Trade Center, Old P.B. Road, Belagavi – 590001. Ph : 95353
70824.
Uttar Vidya Poshak, 2nd Floor, Dundshi Complex, Ashok Nagar,TSS Road,Sirsi,
Kannada and Uttara Kannada-581402,. Ph : 98448 30009.
Shivamogga
Vijayapur and Vidya Poshak, BLDE Associations’ Shri Siddeshwar Art Institute,
Bagalkot Maddinakhani, BLDE Hospital Road, Vijayapur-586101. Ph : 08352-
224210.

 Special Note:
 Completed applications should reach Vidya Poshak by 15th of June 2018. Applications
received after this date will not be entertained
 Please keep the contact number used in application form for the vidya Poshak
financial assistance .All the communications with the students will be through
this contact number only.
 Students joining science stream in 1st year PUC are not eligible to apply for the Vidya
Poshak financial assistance.
 Complete information, guidelines, instructions, terms and conditions are posted
on our website www.vidyaposhak.ngo OR can be obtained using Ph : 0836-2747357,
or Email :info@vidyaposhak.org