PROFORMA

NATIONAL BOARD OF HIGHER MATHEMATICS

APPLICATION FOR M.A./M.Sc. SCHOLARSHIP IN MATHEMATICS

NAME (In BLOCKLETTERS) : ………………………………………………………….

Date of Birth : …………\……………\………… Paste a
Nationality : ………………………… Gender (Male/Female): ……………….……. Photograph
here.
Choice of two Centers in the zone to which application is sent : ……………………….
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Address for the correspondence (IN BLOCK LETTERS) with (PINCODE) : ……………………………………..
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E-mail address : ……………………………………………………………………………………………………..

Telephone : Landline (with STD code) : ……………………………………………………………………………
: Mobile : …………………………………………………………………………...

Name and Address of Current Institution of Study / Affiliation (if applicable) : ………………………………….
…………………………………………………………………………………………………………………………
Name of the Class in which you are currently studying and course (if applicable) : ………………………………
………………………………………………………………………………………………………………………….

University / Exam passed/ Year of Division / Class % marks in

Institution Board Appeared for Passing % marks mathematics

Any relevant information in support of your candidature including awards or scholarships : …………………………..
………………………………………………………………………………………………………………………………..
Whether you had applied for NBHM scholarship in the past ( yes/ no ) : ………………………………………………..
If ‘yes’, give year(s) of application, whether called for test/interview and the outcome .

Place : Signature of the applicant

Date :