Scholarship Form

01. Personal Details

First Name

Middle Name

Surname

Date of Birth required

02. Permanent Address Details

House No

Landmark/Locality

City/Village

Pin Code

03. Mailing Address Details

Check if same as above

Hourse No

Landmark/Locality

City/Village

Pin Code

04. Contact Information Details (applicant will be contacted using the following information)

First Name

Phone Number

05. Legal Guardian Details

*If father deceased, then mother's name. If both deceased, then legal guardian name is required.

First Name

Surname

Occupation

06. Other Family Member Details

Fill out the following for the other family members in the household: (Type in NA wherever it is not applicable)

First Name

Occupation

First Name

Occupation

First Name

Occupation

Total number of family members in household

Annual Household Income (after taxes) in Rupees

07. Past Academic Details

10th Grade (Secondary School)

Marks (in % only)

Year of Passing

Check if marks are in GPA/CGPA

Institution Name

City/Village

State & Pincode

Name of Principal

Phone No.

12th Grade (Higher Secondary School)

Check if the result is awaited

Marks (in % only)

Year of Passing

Check if marks are in GPA/CGPA

Institution Name

City/Village

State & Pincode

Name of Principal

Phone No.

08. Current Academic Details

Institution Name

City/Village

State & Pincode

Name of Principal

Phone No.

09. Estimated Annual Expense Details (in Rupees)

Admission Fees

Tution Fees

Book Expenses

Lodging Expenses

Food Expenses

Other Expenses:

Total Expenses

10. Other Details

1. Why do you believe you are deserving of this scholarship? (Minimum 200 words)

2. What do you aspire to be? (Minimum 100 words)

11. Reference Details (You can add the name of the Head of Department and/or the Principal of your Higher Secondary College here)

Full Name

Phone No.

Occupation

Full Name

Phone No.

Occupation

I hereby declare that the information I have provided in this form is true to the best of my knowledge and belief. If I am found eligible for a scholarship, I undertake to provide additional supporting documents, as required. I would be grateful if you could advise me on the next steps.