APPLICATION FOR STIPEND TO SCHEDULED TRIBE STUDENTS OF ARUNACHAL PRADESH (Fresh/Renewal) FOR THE ACADEMIC SESSION________________________ PART-I Space for (To be filled by the student) recent passport size (This application should be submitted through the head of institution) Photograph 1. Name (in block letter) :................................ 2. Father's name :.................................... 3. Mother's name: ................................... 4. Tribe :..................................... 5. Permanent Address:................................. 6. Course of study undertaking:.............................. 7. The name of the last examination passed:.......................... 8. Name of the institution where studying :......................... 9. Date of admission in the institution :...................... 10. Address for correspondence (Details Postal address of the Institution) ......................................... ......................................... ......................................... Phone No. (If any):................................. 11. Year of nomination (in case of technical course):........................ 12. Name of nearest SBI Branch and its code numbers with full address:............ ........................................... 13. The following certificates are to be attached : (a) APST Certificate (with attestation): (b) Mark sheet of the last examination passed (with attestation): (No bank draft shall be issued other than State Bank of India branch) 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 : 3. Period of Academic Session : 4. State whether any disciplinary action has been taken against the applicant: 5. 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............... Sign. of the Head of Institution with Seal Designation and Address P A R T -II FORM OF UNDERTAKING TO BE SUBMITTED BY THE STUDENTS FOR AWARD OF STIPEND I, Mr./Ms................... a student of .......... Year (Pass/Hons) Course, bearing Roll No.. of college ..............during the session 200....., do hereby solemnly declare that I will strictly adhere to the rules and regulation for grant of stipend and undertake that: 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-roll 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. 6. I am not serving and drawing pay as Govt. employee. In case of non-fulfillment of the above conditions and violation of any one of other rules and regulations of stipend I will forfeit my right of receiving stipend. Date: Signature of the student: Place: Name of the student:___________________________ Class________RollNo________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 30th November for outside Arunachal Pradesh. 3. Application received after the last date of submission will not be accepted. 4. Incomplete application form shall be summarily rejected without any intimation/ notice to the candidates. Candidates should therefore, fill up the form carefully. 5. Actual payee's Receipt as a token of receipt of stipend must be submitted to this Directorate for record and audit purpose through the disbursing authority of the Institution. If any student fails to submit the same no further stipend shall be awarded in subsequent years. 6. This Directorate will not be responsible if Demand Draft of stipend returns back to this Directorate because of incorrect/wrong address of the institution. 7. For details please visit on official website www.apdhte.nic.in
