Affix your

recent
APPLICATION FORM FOR GRANT OF SCHOLARSHIP photograph
duly
attested

Name
Father Name
Permanent
Address *

Mobile & Tel.

No. *

Email ID *
Educational
Qualifications
(attach copies of
mark sheets)
S. No. Examinations Subjects Board / % School / Remarks
University Marks Collage
1 10th or equiv

2 12th or equiv

3 Graduation

4 M.Sc./M.Tech

5 Ph.D/MS/MD

Academic Awards /
Honors /Distinction
(attach copies)

Contact details of the

supervisor
Topic of current
research

List of publications

Extra Co-curriculum
activities

Source and amount of

fellowship drawn
presently
Total annual parental
income * (attach copy of
income proof)
Profession of the
guardian / parents *
List of enclosures

I do hereby undertake that all the informations given above are true to best
of my knowledge and beliefs.

* Fields are mandatory

Date: _____________ Signature: ________________

Instructions:
1. Enclose all relevant documents for support of your claim for scholarship.
2. Send a separate photograph also.
3. Print and fill this form and send it by ordinary post to :

Mahabir Prasad Singh Foundation for Education and Research

6, Vasant Marg, Vasant Vihar, New Delhi – 110 057