Financial Assistance for Deserving Student

Application Form
Please fill the application form (*required information) and email or post it to our office address with
supporting documents.

A) Referral Information
(If you are not referred by anyone, please skip this section and go to section B)

Full Name* :
(As per School certificate)

Address :
Paste passport size
photo
Home Phone :
(3.5 x 3.5 cms)
Mobile Phone* :

Email* :

B) Student Information
Contact Information

Full Name* :

Gender * :

Date of Birth* :

Address* :

Home Phone* :

Mobile Phone* :

Email :

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C) Educational Information
Pursing/Current Education

Course/Degree* :

Semester /year (If applicable) :

Ex: 3rd semester/2nd year

Name of the Institute* :

Institution Address* :

Past Education

Course/Degree :

Year of Passing :

Name of the Institute :

Marks/Percent/Grade Obtained :

D) Family Background
Father’s Name :

Father’s Occupation :

Mother’s Name :

Mother’s Occupation :

Family Monthly Income :

No. of Brother(s) :

No. of Sister(s) :

(If Beneficiary is not under the care of Parents, please provide the Guardian information)

Guardian’s Name :

Guardian’s Occupation :

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E) Scholarship Information
(We cannot process your application with any missing information in this section. Cheque is payable to educational
institute only and cannot be given to beneficiary, parents or any other individual.)

*Reason for Scholarship :

*Total Fee Amount :

*Requested Fee Amount :

*Fee/Payment Due Date :

*Cheque Payee Name :

*Cheque Payee Address :

F) Documents Needed
Family:

 Family Ration Card**

 Family Income Certificate and other income proofs** (salary slip, payment voucher, etc.)

 Last 2 months bank statement of beneficiary & family (if applicable)

Two photos Identification** (Father/Mother/Beneficiary - Voter’s ID / PAN Card /Aadhaar ID)

Beneficiary:

 Complete School (10th, 12th) & College Mark sheets (up to last semester) **

 Present Institute ID card & Bonafide Certificate**

 Fees structure from present institute** (procured within 2 months)

 Others (please specify)

** Mandatory Documents: Please attach all **documents to process your application

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G) College / School Reference (Department HOD / Headmaster)
Contact Name :

Contact No :

Designation :

Declaration
• I hereby declare the information above is true and correct to the best of my knowledge and
belief.

• I am aware that I will be liable for prosecution if any of the above information is found to be
false.

• I acknowledge that, Aalayam use online crowdfunding platform from their supporters to raise
funds for my education.

• I understand the decision of my application is solely made by Aalayam and I will directly contact
Aalayam for any questions instead of referral or other person.

• I solemnly affirm on oath and do hereby declare that I undertake to return the amount received
from the Aalayam Foundation if it is found that there is suppression of any information by me or
furnishing of any wrong information to avail the scholarship. I am also aware that availing the
scholarship for once will not entitle me to get it as a matter of right for the subsequent period of
study.

Signature :

Date :

Note: Once application is received, Aalayam members will contact you and provide more information.

For fast processing, we recommend you to send the application by email, please use docs@aalayam.org
Or
If you are sending the application by post, please use the below address:

Aalayam Foundation
No.114/3, Ponniamman Koil Street, Sri Mahalakshmi Nagar, Numbal, Chennai, India – 600077
Phone: +91 9884533391

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