NAVARATNAM’S SCHOLARSHIP
NOMINATION FORM
Name of the Employee
Employee ID
Date of Joining
Designation
Department
Employee Family Member Details:
Relation
Spouse
Son / Daughter
Son / Daughter
Son / Daughter
Son / Daughter
* (Put √ mark in Remarks column against whom scholarship is applying and attach Aadhar copy)
Category of Scholarship Application: (Fill the required details)
I. PROFESSIONAL COURSES:
Course
Chartered Accountancy (CA)
/ Institute of Cost and Works
Accountants of India (ICWA)
Company Secretary (CS)
Indian Institute of
Technology (IIT)
National Institute of
Technology (NIT)
Birla Institute of Technology
and Science (BITS)
Bachelor of Medicine,
Bachelor of Surgery (MBBS)
Engineering Course
Company
Location
Gross Salary PM
Mobile Number
Age
Name Occupation / Study Remarks *
(in Yrs)
Nomination
category Institution / Criteria & required forms
(put √ mark)
Completion of Intermediate Level (or)
course completion
(Enclose self-attested certificate copy)
Completion of Executive Programme (or)
course completion
(Enclose self-attested certificate copy)
Admission in the specified 17 IITs in India
(Enclose self-attested rank card copy and admission
details)
Admission in the specified 31 NITs in India
(Enclose self-attested rank card copy and admission
details)
Admission in BITS, Pilani, Goa and Hyderabad campuses
through BITSAT
(Enclose self-attested rank card copy and admission
details)
Secured below 6000 rank in NEET
Got MBBS admission in any recognized college in India.
(Enclose self-attested NEET rank card copy and MBBS
course admission details)
Secured below 4000 rank in Andhra Pradesh, Telangana
and Karnataka state EAMCET
Got Engg admission in any recognized college
(Enclose self-attested Engg rank card copy and course
admission details)
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 NAVARATNAM’S SCHOLARSHIP
NOMINATION FORM
II. UNDERGRADUATE / GRADUATE / POST GRADUATE COURSES:
Nomination
Course category Institution / Criteria & required forms
(put √ mark)
CBSE : >= 8.5 grade points
SSC / Xth State : >= 9.0 GPA
(Enclose self-attested marks / score card copy)
CBSE : >= 8.5 grade points
State : >= 90%
Intermediate
(Enclose self-attested marks / score card copy of
two years)
>= 80% score (or) equivalent GPA/CGPA/Grade
Graduation
(Enclose self-attested marks lists copies of three
(B.Sc., B.A., B.Com,. BBA etc.)
years, provisional certificate etc.)
Post-Graduation >= 80% score (or) equivalent GPA/CGPA/Grade
(MBA, MHRM, M.Sc., M.A., (Enclose self-attested marks lists copies of three
M.Com etc.) years, provisional certificate etc.)

III. VARUN TRINING INSTITUTE (VTI) STUDENTS:

Location of VTI General Attitude of Trainee Excellent / Very Good

Student Name Attendance % (>= 95%)
Student ID Discipline Very Good / Good
Learning & Skill
D O J in VTI Excellent / Very Good
Demonstration
Trade Skill Test Score % (>= 95%)
Training
Completed on
(VTI Principal has to submit the relevant attested documents of the concerned student)

IV. MERITORIOUS SPORTSMEN:

Name of Tournament Place & Period of

Standard
Sport Event Participated Participation
International / National / State /
District Level
(Strike off non-applicable
standard)
(Relevant self-attested participation certificates (or) any other proofs to be attached)

Declaration
I hereby declare that above information is correct and complete in all respects and nothing has been
concealed. I am aware that hiding of any information might impair the scholarship eligibility of my son /
daughter in addition to initiating disciplinary action against me.

(Signature of the Employee)

Date:

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