SC, ST & SCC (BC-Adi Dravidar Christian) Scholarship - Fresh Application Form

IMPORTANT NOTE:

THE FOLLOWING DOCUMENTS (XEROX COPY) SHOULD BE ENCLOSED ALONG WITH

THE SCHOLARSHIP APPLICATION FORM OTHERWISE THE APPLICATION WILL BE

LIABLE TO BE REJECTED.

1). Attested Photocopy of Community Certificate.

2). Attested Photocopy of Income Certificate (2018).

(Income certificate period should not exceed 6 months at the time of admission)

UG Students:

(Income limit for SC/ST Candidates – Below Rs. 2,50,000/-)

(Income limit for SCC (BC - Adi Dravidar Christian) Candidates – Below Rs. 2,00,000/-)

(Income limit - above Rs. 2,50,000 to Rs. 9,99,999/- Eligible for Free Education
Scholarship)

PG Students:

(Income limit for SC/ST Candidates - Below Rs. 2,50,000/-)

(Income limit for SCC (BC - Adi Dravidar Christian) Candidates - Below Rs. 2,00,000/-)

(Income limit for PG Girls only - above Rs. 2,50,000 to Rs. 9,99,999/- Eligible for
Free Education Scholarship)

3). Attested Photocopy of Student Savings Bank Pass Book with full transactions.
(*Linking Bank A/c. No. to Aadhaar is mandatory)

4). Attested Photocopy of SSLC (10th) Mark Sheet(s).

5). Attested Photocopy of Hr. Sec. (12th) Mark Sheet(s).

6). Attested Photocopy of UG, PG Mark Sheets, Provisional/Degree Certificate.

(for PG & M.Phil. Students only)

7). Attested Photocopy of Aadhaar Card. (*Linking Aadhaar No. to Bank A/c. is mandatory)

(The Students those who want to submit an application in the College office for claiming
scholarship are requested to take printout on both sides from 2nd page onwards in A4 size
paper (except 1st page).
[

APPLICATION SUBMISSION LAST DATE : Before 10th August 2018.

College Main Office – Counter No.3

*******
 DEPARTMENT OF ADI DRAVIDAR & TRIBAL WELFARE
FRESH - Application form for ADW Scholarship Scheme (Tamil Nadu e-District)
--------------------------------------------------------------------------------------------------------
INSTITUTION NAME : SACRED HEART COLLEGE (Autonomous), Tirupattur, Vellore Dt.
--------------------------------------------------------------------------------------------------------
for office use only (Student ID)
2 0 1 8 0 4 0 1 0 A D W 0 0
--------------------------------------
ACADEMIC DETAILS :
Academic Year : 2018 - 2019 Shift - I (Aided) / Shift - II (Self-Supporting Course)
Course Name : Year : I/ II / III
Studying Course Type : Self Support / Regular Lateral Entry : Yes / No
Date of Admission : .……./……../2018 Student Reg. No.:
-----------------------------------------------------------------------------------------------------------------------------

PERSONAL DETAILS :
Name of the Applicant :
(Block Letters - as per 12th Mark sheet)

Father / Guardian Name : Mother Name :

Occupation : Date of Birth : ___ /___ /_______

Community : SC / ST / SCC (BC - Adi Dravidar Christian) Caste :

Gender : Male / Female Religion : Hindu / Christian
Annual Family Income : Rs. _______________ Admission Mode : Govt. / Payment
(Income Certificate period should not exceed 6 months at the time of admission)
First Graduate : Yes / No 10th Reg. No. _____________ 12th Reg. No. _____________
------------------------------------------------------------------------------------------------------
Email ID: Mobile No. :
------------------------------------------------------------------------------------------------------
Address for Correspondence : Door No. :
Street / Nagar :
Village :
Post :
Taluk :
District :
Pin Code :
Aadhaar No.: (12 Digit No.)
* Linking Aadhaar No. to Bank A/c. is mandatory
--------------------------------------------------------------------------------------------------------
BANK DETAILS :
Student Bank Account Number :
(*Linking Bank A/c. No. to Aadhaar is mandatory)
(Please enter the full digits of Account Number)
Name of the Bank : Branch Name :
IFSC Code: 0 MICR:

(IFSC Code should be 11 Digit.) (MICR Code should be 9 Digit.)

HOSTEL DETAILS :
Hosteller : Yes / No If Yes : Paid Hostel / Free Hostel
Hostel Name :
Date of Joining : ….. / ……. / 2018 Date of Leaving : 31/05/2019
--------------------------------------------------------------------------------------------------------

Date : ___ / ___ / 2018 Signature of the Applicant

 M.jp.g.e. 73---1>000---2016----m.fp.m.> GJif.

jkpo;ehL muR
GOVERNMENT OF TAMIL NADU
Mjpjpuhtplu; kw;Wk; goq;Fbapdu; eyj;Jiw
ADI-DRAVIDAR AND TRIBAL WELFARE DEPARTMENT
kj;jpa / khepy muR fy;tp cjtpj; njhif jpl;lk; - gs;sp ,Wjp Nju;Tf;F Nkw;gl;l gbg;gpw;Fupa
cjtpj; njhif ngWtjw;fhd tpz;zg;gk;

FORM TO APPLY FOR THE GRANT OF GOVERNMENT OF INDIA / STATE GOVERNMENT

POST MATRIC SCHOLARSHIPS.

SACRED HEART COLLEGE (Autonomous),

TIRUPATTUR - 635 601, VELLORE DT.

REG. NO.: khztupd; Gifg;gl

CLASS : I - efy; ,izf;fg;gl
YEAR : 2018 - 2019 Ntz;Lk;
STUDENT ID :
201804010ADW00

1. khztu; ngau; :
(njspthd vOj;Jf;fspy;)
jpU / jpUkjp / nry;tp.
Full Name of the Student (in Block letters)
Thiru / Thirumathi / Selvi.

2. jha; / je;ij / ghJfhtyu; ngah; :

Name of the Mother / Father / Guardian.

3. njhopy; / Occupation. :

4. epue;ju Kftup / Permanent Address. :

5. m. khztu; gapYk; gbg;Gg; gpupT :

Course of Study of the applicant.

1. Nky;epiy tFg;G / Higher Secondary Class.

2. gl;lg;gbg;G / Degree Course.
3. gl;l Nkw;gbg;G / Postgraduate Course.
4. njhopw;gbg;G / Professional Course.
5. gl;lag; gbg;G / Diploma Course.
6. rhd;wpjo; gbg;G / Certificate Course.

M.jp.g.e. 73---1
 2

5. M. gapYk; Kiw / Category of Study.

1. gfy; Neuk; / Day Time
2. khiy Neuk; / Evening Time
3. gFjp Neuk; / Part-Time
4. mQ;ry; top / Correspondence
,. gbg;G Kiw fhy msT / Duration of Course 3 Years, 2 Years, 1 Year

6. gapYk; epWtdj;jpd; ngaUk; mjd; KOikahd

mQ;ry; Kftup. SACRED HEART COLLEGE
(AUTONOMOUS)
Name of the Institution where studying and its TIRUPATTUR - 635 601, VELLORE DIST.
complete Postal Address.
7. fy;tp epiyaj;jpy; Nru;e;j ehs; ehs; khjk; Mz;L
Date of Joining the Institution Date Month; Year
2018
8. gj;jhk; tFg;G nghJj; Nju;tpy; Nju;r;rp ngw;w Mz;L gjpT vz;.
Mz;L / gjpT vz;. Year Registration No.
Year and Register No. of Passing of the10th
Public Examination.
9. gl;bay; ,dj;jtu; / goq;Fbapdu; / fpwp];jt 1. gl;bay; ,dj;jth;
,dj;jpw;F khwpa gl;bay; ,dj;jtu; Scheduled Caste
(tl;lhl;rpau; toq;fpa epiyahd rhjpr;
rhd;wpjopd; Gifg;gl efy; ,izf;fg;gl 2. fpwp];jt kjj;jpw;F khwpa
Ntz;Lk;). gl;bay; ,dj;jtu;
goq;Fbapdu; ,dj;ijr; Nru;e;jtu; vdpy; tUtha; Scheduled Caste Converted to
Nfhl;lhl;rpau; rhd;wpjo; my;yJ 11-11-1989-f;F Christianity.
Kd;du; ngw;w tl;lhl;rpau; rhd;wpjopd; Gifg;gl
efy; ,izf;fg;gl Ntz;Lk;. Cgrhjp ngau; goq;Fbapdu;
3.
Fwpg;gpLjy; $lhJ. Scheduled Tribe.
Scheduled Caste / Scheduled Tribes / Scheduled
Caste Converted to Christianity. A xerox copy of the
Community Certificate issued by the Tahsildar in
respect of SC / SC Christian and certificate issued by
the R.D.O. or the certificate issued by the Tahsildar
before 11-11-1989 in respect of S.T. should be
attached Sub Caste should not be mentioned.

10. tpz;zg;gjhuupd; ngw;Nwhu; (jha; / je;ij)

ghJfhtyu; / fztupd; gy;NtW tifapy; <l;ba
nkhj;j Mz;L tUkhdk; (tpz;zg;g ehSf;F Rs.
Ke;ija MW khjq;fSf;Fs; ngwg;gl;l
tl;lhl;rpau; rhd;wpjo; ,izf;fg;gl Ntz;Lk;).
Gross annual income of the parent / guardian /
husband from all sources to be furnished (income
certificate issued by the Tahsildar and obtained
within Six months period to date of application
should be attached).

.
 3

11. gj;jhk; tFg;Gf;Fg;; gpd;du; gapd;w gbg;Gfspd;

tptuk; / ,ilepWj;jk; ,Ug;gpd; mjd; tptuk;.
Details of Postmatric Courses after 10th standard in
which applicant studied / Details of break of study
should be furnished.
gapd;w Mz;L fy;tp epiyaj;jpd; ngau; fy;tp cjtpj; njhif tUif tpOf;fhL
gbg;G tptuk; Name of the Institution ngwg;gl;ljh? nrd;w Mz;Lf;F
kl;Lk.;
Details of study Whether obtained Percentage of previous
undergone together Scholarship. year attendance.
with year of study. Mk; / ,y;iy
Yes / No
(1). (2). (3). (4).

12. khzthpd; tq;fp fzf;F vz;.

Student Bank Account Number. :
1. tq;fp ngah; / Bank Name :
2. tq;fp fpis / Bank Branch :
3. MICR FwpaPL / MICR Code :
4. IFSC FwpaPL / IFSC Code :
5. kpd;dD jPh;it gw;W chpikf; fl;lis gbtk;
my;yJ tq;fp fzf;F Gj;jfj;jpd; Kjy; gf;f Mk; / ,y;iy
efy; ,izf;fg;gl;Ls;sjh? Whether ECS credit
mandate form enclosed? or enclosed Bank Pass Book Yes / No
First Page Copy.
6. kpd;dD jPh;it / Njrpa kpd;dD epjp ghpkhw;wk; /
RTGS Kiwapy; fy;tp cjtpj; njhifis Mk; / ,y;iy
Nrkpg;Gf; fzf;fpy; Nrh;f;f khzthpd; Nrkpg;G
fzf;F guhkhpf;fg;gLk; tq;fp Core Banking
solution trjp mspf;fg;gl;l tq;fpah? Yes / No
To Facilitate ECS / NEFT / RTGS Transactions
whether the Bank is CBS enabled?
7. khzthpd; njhiyNgrp / miyNgrp vz;.
Student Phone / Cell Number.

,lk;: khztu; / khztpah; ifnahg;gk;

Station: Tirupattur, Vellore Dt. Signature of Applicant
ehs;:
Date: ___ / ___ / 2018.
M.jp.g.e. 73---2
 4

cWjpnkhop
DECLARATION

vdJ Foe;ijfspd; tptuq;fs; kw;Wk; mtu;fs; ngw;w fy;tp cjtpj; njhif tptuq;fs;
Details of my Children and the details of Scholarships received by them for
Postmatric studies.

njhlu; ngau; ,Wjpahfg; gbj;j ngwg;gl;l my;yJ ngwg;gl;l

vz;> kw;Wk; jw;nghOJ tpz;zg;gpj;Js;s gbg;Gjtpj;
gbf;Fk; fy;Y}upapd; njhiff;Fupa njhif.
ngau;. Mz;L.
Serial Name Name of the Year of which Amount of
Number Educational Institution scholarship Scholarship
last studied and now received or received
studying applied for
1. 2. 3. 4. 5.

Fwpg;G:- ngw;w midj;Jf; fy;tp cjtpj; njhiffisg; gw;wpAk; Fwpg;gpl Ntz;Lk;.

Details of all Scholarship received by your children should be furnished.

,t;tpz;zg;gj;jpYk; Nkw;fz;l cWjpnkhopapYk; mspf;fg;gl;Ls;s tptuq;fs; rupahdit

vdTk;> mit rupahditay;y vd;W fz;lwpag;gl;lhy; jw;NghJ tpz;zg;gpj;Js;s jpU / jpUkjp /
nry;tp ……………………………………. mtu;fSf;F xg;gspf;fg;gl;l gbg;G cjtpj; njhif
KOtijAk; muR tpjpf;Fk; ve;j topapYk; jpUg;gpaspf;f ,irfpNwd; vdTk; kdkhu cWjp
mspf;fpNwd;.

I solemnly declare that the particulars furnished in the application as well as in this declaration are
correct and if they are found to be false later on, I agree to refund the entire amount of scholarships paid to
Thiru / Selvi / Thirumathi ……………………………………. who has now applied for Scholarship
through whatever means the Government deem proper and fit.

,lk;: ngw;Nwhh; /fhg;ghsupd; ifnahg;gk;

Place: Signature of Parent / Guardian.

ehs;:
Date:
 5

fy;tp epiyaj; jiytuhy; epiwT nra;ag;gl Ntz;baJ

TO BE FILLED BY THE HEAD OF THE INSTITUTION

1. khztu; tFg;gpy; Nru;e;j ehs;.

Date of which the applicant joined the class this year.
2. ,e;j Mz;by; Nju;T KbAk; khjk;.
Month in which the annual examination in the April - 2019
current year will be over.
3. khztu; tpLjpapy; jq;fpg; gapy;gtuh?
Where the applicant is residing in the hostel?
m. tpLjpapd; ngau; / Name of the Hostel.
M. tpLjp fy;tp epiyaj;Jld; ,ize;Js;sjh?
Whether the hostel is attached to the institution?
,. jdpahu; tpLjpah? ,ytr czT> ciwtplk;
toq;fg;gLfpwjh?
Whether the hostel is run by the private
management and whether free boarding and
lodging is provided.
<. muR tpLjpah Mk; vdpy; tptuq;fs;
mspf;fTk;.
Whether the student is staying in the Govt. Hostel.
If so indicate details there for.
(i) Mjp jpuhtplu; eyj;Jiw.
Adi-Dravidar Welfare Department.
(ii) gpw;gl;Nlhu; eyj;Jiw.
Backward Class Welfare Department.
(iii) kpfg;gpw;gl;Nlhu;> rpWghd;ikapdu; eyj;Jiw.
Most Backward Class and Minorities Welfare
Department.
4. khztu; tpLjpapy; Nru;e;j ehs;.
Date on which the student joined the hostel.
5. tpLjp fhg;ghsupd; ifnahg;gk;.
Signature of the Warden.

6. khztu; ngw;Ws;s tUif tpOf;fhL.

Percentage of Attendance obtained by the student.
7. khztu; elj;ij Fwpj;J rhd;wpjo;.
Character of the student.
8. khztUf;F fy;tp cjtpj;njhif toq;f gupe;Jiu.
Recommendation of the Head of the Institution for
the grant of Scholarship.

fy;tp epiyaj; jiytu;

Heads of the Institution.
 6

kj;jpa muR Ngh];l; nkl;upf; fy;tp cjtpj; njhif ngWk; khztu;fSf;F kl;Lk;.
cly; CdKw;w ,e;J Mjp jpuhtplu; / goq;Fbapdu; khztu;fSf;fhf $Ljy; rYif.

tpz;zg;gjhuu; cly; CdKw;wtuh? Mk; / ,y;iy

Mk; vdpy; gpd;tUtdtw;wpy; nghUj;jkhdij bf; ( ) nra;aTk;

1. ghu;itf; FiwT / Low Vision ( )
2. fhJ Nfl;gjpy; FiwAs;sth; / Deaf ( )
3. njhO Nehapy; ,Ue;J kPz;ltu;fs; / recovered from ( )
leprosy.
4. kdNehahy; ghjpg;gile;jtu;fs; / Physcholagically affected. ( )
5. if> fhy;fs; tsu;rr ; papd;wp topj;Jizahsh;fspd; ( )
cjtpAld; fy;Y}upf;Fr; nry;gtu; / Orthopedically
handicapped going to college with the help of a guide.
6. if> fhy;fs; tsu;rr ; pf; Fiwthy; CdKw;W fy;Y}upAld; ( )
,ize;j tpLjpapy; jq;fpapUg;gtu;fs; / Orthopedically
disabled studying in institution run for physically challenged
person as hosteller attached to the institution.
7. %is tsu;rr ; p Fd;wpatu;fSf;fhd rpwg;G gapw;rp ( )
ngWgtu;fs; / Special coaching for mentally retarded person.
NkNy tupir vz; (5)-y; Fwpg;gpl;Ls;s
topj;Jizahsh;fs; cjtpAld; fy;Y}hpf;F
nry;gth;fshf ,Ue;jhy;.

1. topj;Jizahshpd; ngah; / Guide Name

2. Kfthp / Address

topj;Jizahsupd; ifnahg;gk; / Guide Signature

Nkw;fhZk; nghUs;fspy; nghUj;jkhdtw;Wf;F cjtp kUj;Jt mYtyu; (Civil Assistant

Surgeon) epiyf;F Fiwahj muR kUj;Jt mYtyuplkpUe;J rhd;wpjo; ngw;W ,izf;f
Ntz;Lk;.

NkNy tupir vz; (5) kw;Wk; (6)-y; nra;jpUe;jhy; tpz;zg;gjhuupd; jw;Nghija KO cUt
epow;glj;jpid FwpaPl;Lj; jhspy; ,izf;f Ntz;Lk;.
 7

rhpghh;g;G gl;bay; / Check List

Gifg;glk; / Photocopy ,ilepWj;jk; ,Ug;gpd; ,ilepWj;j

rhd;wpjo; / Break Certificate

rhjprhd;W / Community Certificate kjpg;ngz; rhd;Wfs; / Mark

Certificate

tUkhdr;rhd;W / Income Certificate tq;fp fzf;F Gj;jf Kjy; gf;f

efy; / kpd;dD jPh;it gw;W chpikf;
fl;lis gbtk; / Whether ECS credit
mandate form enclosed? or enclosed
Bank Pass Book First Page Copy.

tUifr; rhd;W / Attendance Certificate

 REG. NO. : ……………………….. M.jp.g.e. 74 & 75-1>000-2006-m.fp.m.> GJif
CLASS :I- jkpof muR
YEAR : 2018 - 2019 GOVERNMENT OF INDIA
Mjpjpuhtplh; kw;Wk; goq;Fbapdh; eyj;Jiw
ADI-DRAVIDAR AND TRIBAL WELFARE DEPARTMENT
fy;tp cjtpj; njhif STUDENT ID :
GjpaJ / GJg;gpj;jy; 201804010ADW00
FwpaPl;Lj;jhs;
1. fy;tp epiyaj;jpd; ngah;> Kfthp : SACRED HEART COLLEGE (AUTONOMOUS)
Institution Name and Address. TIRUPATTUR - 635 601, VELLORE DIST.
2. (1) gl;bay; ,dj;jth;. :
Scheduled Caste.
(2) fpwpj;Jt kjj;jpw;F khwpa gl;bay; ,dj;jth;. :
Scheduled Caste Converted to Christianity.
(3) goq;Fbapdh; Scheduled Tribes :
(rk;ke;jg;gl;l FwpaPl;L vz;izf;
Fwpg;gpl Ntz;Lk;)
(mentioned the correct serial numbers)
3. Mz; (M) / ngz; (ng). :
Boys / Girls
4. (m) khztp / khzth; ngah; :
Students Name
(M) gj;jhk; tFg;gpy; Njh;r;rp ngw;w Mz;L :
Year and Register No. of passing of the 10th
Public Examination.
(,) gjpT vz; :
Registration Number.
5. jha; (m) je;ij / ghJfhtyh; ngah; :
Name of the Mother / Father / Guardian
(a) FLk;g Mz;L tUkhdk;. :
Family yearly income.
6. epue;ju Kfthp
Permanent Address.

7. nrd;w Mz;L gbj;j tFg;G, cjtpj; njhif

ngw;w gbg;Gg; gphptpd; tptuk;:-
Class studied in previous year particulars of
the course for which scholarship received.
(m) (1) Nky;epiyg; gbg;G / :
Higher Secondary Class
 2
(2) gl;lg;gbg;G / Degree Course.
(3) gl;l Nkw;gbg;G / Post Graduate Course.
(4) njhopw;gbg;G / Professional Course
(5) njhopy;El;gg; gbg;G / Polytechnic Course
(6) rhd;wpjo; gbg;G / Certificate Course.
(M) nrd;w Mz;L gapd;w gbg;G.
(1) 1Mk; Mz;L / 1st Year
(2) 2Mk; Mz;L / 2nd Year
(3) 3Mk; Mz;L / 3rd Year
(4) 4Mk; Mz;L / 4th Year
(5) 5Mk; Mz;L / 5th Year
(,) nrd;w Mz;L tpLjpapy; Nrh;e;j ehs;.
Date on which the applicant joined the
hostel last year.
8. ,e;j Mz;L gbf;Fk; gbg;G kw;Wk; Mz;L.
Course studying at present and the year of study.

(m) ghlg;gphpT (Kf;fpag; ghlg;gphpT Fwpg;gpLf) / Subject

(M) gapYk; Mz;L

(1) 1Mk; Mz;L / 1st Year
(2) 2Mk; Mz;L / 2nd Year
(3) 3Mk; Mz;L / 3rd Year :
(4) 4Mk; Mz;L / 4th Year
(5) 5Mk; Mz;L / 5th Year
9. ,e;j Mz;L fy;Y}hp Jtq;fpa ehs;.
1 8
College re-opening date for the year
khjk; / Month 0 6

Mz;L / Year 2 0 1 8

10 tpLjpapy; Nrh;e;j ehs; / Joined the Hostel.

.
khjk; / Month
11 tpLjp tifg;ghL / Classification of Hostel.
(1). mq;ffP hpf;fg;gl;l jdpahh; tpLjp (,ytr czT kw;Wk; ciwAs;).
approved or recognized private hostel (free food and accommodation).
(2). mq;ffP hpf;fg;gl;l jdpahh; tpLjp (czT kw;Wk;
ciwAs;Sf;fhf fl;lzk; tR+ypf;fg;gLfpwJ).
recognized private hostel (fees collected for food & accommodation).
(3). Mjpjpuhtplh; eyj;Jiw tpLjp
Adi Dravidar Welfare Department Hostel.
(4). gpw;gl;Nlhh; eyj;Jiw tpLjp
Backward Department Hostel.
 3
(5). kpfTk; gpw;gl;Nlhh; kw;Wk; rpWghd;ikapdh; eyj;Jiw
tpLjp. (MBC and Minority Welfare Department Hostel).
(6). fy;tp epWtdj;Jld; ,ize;j tpLjp (nghUj;jkhd
vz;fis Fwpg;gplTk;) cly; CdKw;w ,e;J
Mjpjpuhtplh; / goq;Fbapdh; khzt / khztpah;fSf;fhd
$Ljy; rYif.
(Note appropriate number). Additional connection for
Physically disabled HAD / Tribal Boys / Girls.
12. Njh;T KbAk; khjk; / Exam closure Month 0 4
Mz;L / Year
2 0 1 9
13. fle;j Mz;L fy;tp cjtpj; njhif ve;j khjk; tiu
toq;fg;gl;lJ. 0 4
Till which month last year Scholarship was sanctioned.
14. cjtpj; njhif ,e;j Mz;by; ve;j khjj;jpypUe;J
0 6
toq;fg;gl Ntz;Lk;. / From which month this year
Scholarship has to be sanctioned.
15. khzth; Njitahd tUif tpOf;fhL ngw;Ws;shuh? Mk; ,y;iy
Does the student attained needed attendance percentage?
16. tpz;zg;gjhuh; cly; CdKw;wtuh? Mk; ,y;iy
Whether the applicant of physically disabled.
Mk; vdpy; nghUj;jkhdtw;iw bf; ( ) nra;aTk;.
if yes tick ( ) the suitable
(m). ghh;itf; FiwT / Low vision
(M). Nfl;Fk; jpwd; Fiwte;jth; / Deaf

(,). njhONehapy; ,Ue;J kPz;lth; / recovered from leprosy

(<). kdNehahy; ghjpg;gile;jth; / Physcholagically affected

(c). if> fhy;fs; tsh;rr ; pFd;wp topj; Jizahsh;

cjtpAld; fy;Y}hpf;Fr; nry;gth; / Orthopedically
handicapped going to college with the help of a guide.
(C). if> fhy;fs; tsh;rr ; pf; Fiwthy; CdKw;w
fy;Y}hpAld; ,ize;j tpLjpapy; jq;fp gapy;gth; /
Orthopedically disabled studying in institution run for
physically challenged person as hosteller attached to the
institution
(v) %is tsh;rr ; p Fd;wpath;fSf;fhd rpwg;Gg; gapw;rp
ngWgth; / Special coaching for mentally retarded person.
17. khzthpd; tq;fp fzf;F vz;.
Student Bank Account Number. :
1. tq;fp ngah; / Bank Name :
 4
2. tq;fp fpis / Bank Branch :
3. MICR Code / MICR FwpaPL :
4. IFSC Code / IFSC FwpaPL :
5. tq;fp fzf;F Gj;jfj;jpd; Kjy; gf;f efy; /
,izf;fg;gl;Ls;sJ my;yJ kpd;dD jPh;it Mk; / ,y;iy
gw;W chpikf; fl;lis gbtk; / enclosed Bank
Pass Book First Page Copy or ECS credit mandate form Yes / No
enclosed?
6. kpd;dD jPh;it / Njrpa kpd;dD epjp ghpkhw;wk; /
RTGS Kiwapy; fy;tp cjtpj; njhifia Nrkpg;Gf; Mk; / ,y;iy
fzf;fpy; Nrh;f;f khzthpd; Nrkpg;G fzf;F
guhkhpf;fg;gLk; tq;fp Core Banking solution trjp Yes / No
mspf;fg;gl;l tq;fpah?
To Facilitate ECS / NEFT / RTGS Transactions
whether the Bank is CBS enabled?
7. khzthpd; njhiyNgrp / miyNgrp vz;.
Student Phone / Cell Number :

khzth; ………………………………………………….. ghjpg;gpdhy; cly; CdKw;wth;

vd;Wk; khzth; fy;Y}hpAld; ,ize;j tpLjpapy; jq;fp gapy;fpwhh; / topj;Jizahsh; cjtpAld;
fy;Y}hpf;F te;J nry;fpwhh; / %is tsh;rr
; p Fiwe;jth;fSf;fhd rpwg;Gg; gapw;rp ngWgth; vd;Wk;
rhd;wspf;fpNwd;. chpa rhd;Wfs; ,izf;fg;gl;L rhpghh;f;fg;gl;lJ.

Certified that the students ……………………………………………..……….. defect is physically

challenged and is studying in the institution as hosteller attached to the institution coming to
institution with the help of a give / receiving special training for mentally retarded person. Due certificate
are enclosed and verified.

18. fy;tp epiyaj; jiyth; ghpe;Jiu: kj;jpa / khepy muR cjtpj; njhif toq;Fk;
tpjpKiwfSf;F cl;gl;L khzth; / khztpah; GJg;gpj;jy; cjtpj; njhif ngw jFjp cilath;
vdTk; khzth; / khztpaUf;F cjtpj; njhif GJg;gpj;J toq;fyhk; vdTk; ghpe;Jiu
nra;fpNwd;.

18. Recommendation of Head of Institution:- Certified that the student is eligible for renewal
scholarship amount subject to central / State Government rules and the students in recommended for
sanction of renewal scholarship.

fy;tp epiyaj; jiythpd; ifnahg;gk;

mYtyf Kj;jpiu.
Principal Signature with Seal