o"kZ 2019&20 esa jkT; ls ckgj dh laLFkkvksa ¼dsoy

’kkldh; ,oa ’kkldh; lgk;rk izkIr laLFkkvksa ds fy;s½ dks

ekLVj MkVk esa lfEefyr gksus ds fy, vkosnu i=&vfUre
frfFk&20 tqykbZ 2019
1- laLFkk dk uke o irk¼fiu dksM lfgr½%&
2- tuin ,oa jkT; dk uke ¼tgka laLFkk fLFkr gS½%&
3- ekU;rk dh vof/k%&
v& ekU;rk iznku djus okys l{ke Lrj foHkkx dk uke@in dk uke----------------------------
--------
ekU;rk nsus dk iz=kad ---------------------------------------------------------------------------------
----------------fnukad-----------------------------
4- f'k{k.k laLFkk dk izdkj %& 'kkldh;@'kkldh; lgk;rk izkIr
5- laLFkk }kjk lapkfyr dkslZ@dkslsZt o mudh fu/kkZfjr Qhl ls lEcfU/kr fooj.k&

dz0la0 dkslZ dk uke dkslZ dk fu/kkZfjr vuqeU;

izdkj Qhl vkns'k dk
¼fu;fer i=kad o
LofoRr fnukad
iksf"kr½
1
2
3
vU;

6- fo'ofo|ky; @laLFkku dk uke o irk ¼ ftlls laLFkk lEc) gS½-----------------------------------

-----------------------------------------------------------rFkk lEc)hdj.k dk i=kad------------------------
----------------------------------------------------------------------------------------------fnukad------------
-----------------

7- 'kS{kf.kd o"kZ 2019&20 esa laLFkk esa dkslZokj izosf'kr dqy Nk=ksa ls lEcfU/kr
fooj.k%&

dz0la0 dkslZ dk uke dkslZ dk fu/kkZfjr vuqeU;

izdkj Qhl vkns'k dk
¼fu;fer i=kad o
LofoRr fnukad
iksf"kr½
1
2
3
vU;

8- v& laLFkk dh e-mailI address rFkk VsyhQksu@eksckbZy uEcj%&

c&laLFkk dh osclkbV dk uke%&
l& Nk=o`fRr gsrq laLFkk ds ukfer uksMy vf/kdkjh dk uke&
n&in dk uke ,oa eksckbZy u0&
9- laLFkk esa 'kS{kf.kd o"kZ 2018&19 esa mRrj izns'k jkT; ds izos'k ysus okys dqy
Nk=ksa dh la[;k dk fooj.k%&

vuqlwfpr tkfr vuqlwfpr tu tkfr lkekU; oxZ dqy Nk= la[;k

1 2 3 4
 laLFkk izeq[k ds
gLrk{kj
¼uke o inuke eksgj
lfgr½

layXu djas&
1& laLFkku dh ekU;rk izi=ksa dh izekf.kr Nk;kizfr;kaA
2& dkslZ dh ekU;rk izi=ksa dh izekf.kr Nk;kizfr;kaA
3& l{ke Lrj ls Qhl fu/kkZj.k ls lEcfU/kr izekf.kr Nk;kizfr;kaA
4& Lohd`r Nk= la[;k ¼dkslZokj½ ls lEcfU/kr izekf.kr Nk;kizfr;ka A
5& lEc)rk ls lEcfU/kr izi=ksa dh izekf.kr Nk;kizfr;ka A
uksV& loZizFke Nk=o`fRr iksVZy ls vkuykbu vkosnu lcfeV djsa ,oa funs'kd] lekt
dY;k.k] 3&izkx ukjk;.k jksM ¼dY;k.k Hkou½ y[kuÅ] mRrj izns'k] fiu dksM&226001
ds irs ij LihM iksLV@jftLVMZ Mkd }kjk rFkk bZ&esy ds ek/;e ls
dd.dir3.sw@dirsamajkalyan.in ij mDr lwpuk ,oa izi= miyC/k djk;k tk;A
 YEAR 2019-20 APPLICATION FORM
(FOR INCLUSION OF OUT OF STATE (Govt & Govt Aided Institutes only)
INSTITUTES IN U.P. SCHOLARSHIP MASTER DATA) LAST DATE-20th JULY2019
1- Name of institute & Address (With Pincode) …………………………….
2- Name of state & District (where institute is situated)
3- Duration of recognition .......................................................
A. Name -& post of competant department/Authority for recognition
.......................................................
B. Letter No.of recognition....................................................... Date……..
4- Type of institute--:-Govt/Aided.......................................................
5- Courses run by institute& its fees Structure
Sr.no. Name of course Type of Fees Letter No. Of
course(regular Fixed by recognition
/self finance Competent letter & date
authority
1
2
3
Other
6- Name & address of university & Institute (where institute attached)-------------------------
-------------------------------------------------------------
Letter No and date for affiliation ----------------------------------------------------------------------
-------
7- Statement about sanction seat in institute (academic year 2019-20)

Sr.no. Name of course Type of Total Letter No. Of

course(regular Sanction recognition
/self finance) Seats letter & date
1
2
3
Other

8- A. E-mailI address of institute & Land line No/Mob.No……………………………….

B. Website address……………………………….
C. Name of nodal officer of institute for scholarship…………………………
D. Designation & Mob. No……………….
9- Statement about total students of up state course wise admitted in institute (academic
year (2018-19)

SC ST GENRAL TOTAL

Sign
Head of Institution
(Name & designation with seal)
1- Attested copy of recognition Certificates of institute.
2- Attested copies of courses recognition Certificates.
3- Attested copies of fees fixation letters from competent authority.
4- Attested copies of course wise seats approval letters.
5 - Attested copies of affiliation Certificates.
Note:- Please submit your application online at scholarship portal & send your all
information for inclusion in U.P. Scholarship Master data by
registered/ speed post to DIRECTOR, SOCIAL WELFARE, 3- PRAG NARAYAN ROAD (KALYAN
BHAWAN) LUCKNOW .U.P. PIN CODE – 226001 & at E-mail address dd.dir3.sw@
dirsamajkalyan.in