You are on page 1of 1

CENTRAL UNIVERSITY OF HARYANA

(Established vide Act No. 25 (2009) of Parliament)


Jant-Pali, Mahendergarh
Application No:-
Application for Earn While You Learn (EWYL) Scheme
(Academic Year 20 -20 )
1. Name of the Student
2. Department
3. Programme
4. Community (SC/ST/OBC/General/Other)
5. Minority Group, if any
6. Date of Birth
7. Gender
8. Whether differently-abled Yes/No
9. Whether hailing from Rural/Sub-urban areas
10. Details of Parents/Guardians
Name
Occupation
Annual Income (Income Certificate to be
attached)
11. Present Address ……………………………………………………
……………………………………………………
……………………………………………………
……………………………………………..
12. Permanent Address ……………………………………………………
……………………………………………………
……………………………………………………
……………………………………………..
13. Mobile Number
14. E-mail ID
15. Department Preferences Under EWYL Scheme
16. Do you receive any financial assistance in the form Yes/ No
of any scholarship/stipend from our University or
any other agency?
17. If yes, furnish details
18. Will you be able to balance both your studies and job Yes/ No
under EWYL Scheme?
19. Write in about 50 words as to why do you need to be
considered for the job under the EWYL
Scheme? (Attach a separate sheet)
Declaration: I hereby declare that the information provided above is true to the best of my knowledge.

Signature of HOD Signature of the student

You might also like