FAEA : Scholarship 2023-24

Application Form

* Confirmation Code: 202675770

Personal Details
Name (as it appears in
* your SSLC/SSC TANAZ
certificate)
* Mother's Name Hanseera
* Father's Name Mohd aarif
Email-ID tanajkhan439@gmail.com
* Gender MALE * Date of Birth 06-Jun-2004
* Complete Permanent Address *
Address for Communication
(with Home State/City)
Vpo shikrawa teh punhana dist Nuh
Vpo shikrawa teh punhana dist Nuh
Nuh
Nuh
HISAR
Hisar
HARYANA-122508
HARYANA-122508
Alternate Mobile No./
* Mobile No. 8396951919 9671561919
Telephone No.
Fax No. Aadhar No. 469503222245

Social Details
If SC/ST/OBC, please
* Category OBC-NCL BCB
specify
Do you have BPL
Do you belong to Below
Card?
* Poverty Line (BPL) NO *
If yes, give the BPL
Category?
Card No.
Do you have a
Do you belong to a physical or sensory NO
* Muslim * disability?
Religious Minority?
If yes, please specify
Who was the first person to complete Matriculation (upto class 10) in your immediate family?
*
Parents
Mother's Education
* Father's Education Level Senior School * Not Known
Level
* Father Occupation Farmer * Father's Income 75000
* Mother Occupation Housewife * Mother's Income 10000
Are you presently getting any State Government Scholarship/other scholarship/fee
*
concession/financial help for pursuing Degree Course?(Yes/No)*: NO
What is your approximate total fee expenditure per year (including course fee and hostel fee)?
*
Please write the minimum funds you require per year?: Rs.50000

Educational Background
 Class XIIth Name of the
* School/Diploma Institute Luvas ipvs * Board(Class Haryana
Name? XII/Diploma)?
* Name of the City/ Others
Town/ Village in
which your Class XII
Which type of school did
* Government School/Diploma
you study in?
Institute was located?
If other, please
Nuh
specify
Class XII/Diploma -
Class XII/Diploma Medium
* English * Was it a residential NO
of instruction
(boarding) school

Academic Background
* Year of passing Class X 2019 * Class X percentage 78.8
Year of passing Class Class XII/Diploma
* 2021 * Science
XII/Diploma Exam subject
* Class XII/Diploma percentage: 91%
Class for Basis of Percentage Marks Entered: 12th
Note: Select 11th class onlyif result is awaited for class 12th (Students whose results of class
12th are still awaited may also apply on the basis of 11th Class marks.)
Present Course Pursuing Vldd
* Are you presently pursuing any Course (Graduation/Engineering/Diploma/PG Etc)? YES
if Yes, provide the following information:
Name of Pursuing Currently you are In Year 2023-24, you
the City State Degree/Course studying in the year will be in which
College Name (Course Year) (course year)

Luvas ipvs Hisar Haryana Haryana I II

if others, please
* Proposed Course of Study Science
specify
Why do you want to join this course?(not more than 200 words):
It’s a veterinarian course so I love animals that’s why I join this course

Reference Details

* Reference Name #1 Mohd aarif * Gender Male

Address for
* Vpo shikrawa
Communication
Teh punhana
Distt nuh
* City/District Nuh * Pin Code 122508
* State Haryana
Contact No. with STD Contact No./Mobile
* 9671561919 08396951919
Code/Mobile No. (i) No. (ii)
Fax No. Email-ID tanajkhan439@gmail.com

Reference Name #2 Zeb Ali Gender Male

Address for Vpo shikrawa
Communication
Teh punhana
Distt nuh Haryana
City/District Nuh Pin Code 122508
State Haryana
Contact No. with STD Contact No./Mobile
70157 74062 70157 74062
Code/Mobile No. (i) No. (ii)
Fax No. Email-ID tanajkhan439@gmail.com
Declaration
I hereby declare that I have verified the details indicated above and I confirm that
all the information submitted above is correct to the best of my knowledge. I will
provide documentary evidence in support of all the above information. If at any
stage, if it is found that any of the above information is incorrect and/or is
suppressed, the management of FAEA shall have the right to take penal action as
deemed fit.
Application No. 202675770. Applicated submitted on 18 June 2023 11:13
Place
Date Signature of Applicant

Print

(Please Print the form for Further Reference)