APPLICATION FOR STIPEND TO SCHEDULED TRIBE STUDENTS OF ARUNACHAL PRADESH (Fresh/Renewal) (To be filled by the student) (This application should be submitted through the head of institution) Space for recent passport size Photograph Name (in block letter)1. Father's name2. Mother's name3. Tribe4. Sub-Tribe (If any)5. Religion Permanent Address Course of study undertaking 6. 7. 8. The name of the last examination passed 9. Name of the institution where studying 10. Date of admission in the institution11. PART-I Yes No Published on National Portal of India (india.gov.in) FOR THE ACADEMIC SESSION - (d) State (e) Pin code No (f) Phone No. (If any) Yes No 13. Year of nomination (in case of technical course) 14. Name of nearest SBI Branch and its code numbers with full address 15. Signature of the Student Full Name Class Roll No. CERTIFICATE TO BE COMPLETED BY THE HEAD OF INSTITUTION WHERE THE APPLICANT IS STUDYING 1.Do you recommend the award of stipend 2. Duration of Course Yes No 3. Period of Academic Session ToFrom Published on National Portal of India (india.gov.in) (c) District (b) Post Office Address for correspondence (Details Postal address of the Institution)12. (a) Lane/ Street/ Town The following certificates are to be attached (a) APST Certificate (with attestation) (b) Mark sheet of the last examination passed (with attestation) 5.State whether any disciplinary action has been taken against the applicant Yes No 6. To whom the Bank Draft is to be endorsed Certified that the institution is affiliated to the University and is recognized by the Central/ State Govt. of The applicant is studying in in this Institution The minimum qualification required for admission to this course is PART-II FORM OF UNDERTAKING TO BE SUBMITIED BY THE STUDENTS FOR AWARD OF STIPEND Year bearing Roll No of college during the session 20 do hereby solemnly declare that I will strictly adhere to the rules and regulation for grant of stipend and undertake that:- Published on National Portal of India (india.gov.in) 4.Date of joining of the student in the institution a student of ( Pass/ Hons) Course, Sign. of the Head of Institution with Seal Address Designation I Mr Ms 1. I must secure 75% of attendance in all the subjects. 2. I am not in receipt of any stipend and scholarship from other sources. 3. I am not on the pay-roil of any establishment on account of my employment. 4. I have duly passed the last Board/University examination. 5. I shall abide by all the rules, regulations and maintain discipline in the Institution. In case of non-fulfillment of the above conditions and violation of anyone of other rules and regulations of stipend I will forfeit my right of receiving stipend. Further more, I will inform the principal of the college immediately after I get any employment with monetary benefits. Signature of the student Name of the student Class Roll No. session (Round Seal of the Institution) - Sign. of the Head of Institution with Seal N.B.1. Duly filled up application for stipend should be submitted to the Directorate of Higher and Technical Education, Govt. of Arunachal Pradesh, Itanagar.Pin-791111. 2. The last date of submission is 30th September for student studying within Arunachal Pradesh and so 30th November for outside Arunachal Pradesh. 3. Application received after the last date of submission will not be accepted. 5. This Directorate will not be responsible if Demand Draft of stipend returns back to this Directorate because of incorrect/wrong address of the institution. 6. For details please visit on official website www.apdhte.nic.in Published on National Portal of India (india.gov.in) Place Date 4. Incomplete application form shall be summarily rejected without any intimation/notice to the candidates. Candidates should therefore, fill up the form carefully awarded in subsequent years.
