Download Application for Post Martic Scholarships to Scheduled Caste Students

SCHOLARSHIP FORM NO. 1(FRESH) APPLICATION FOR GOVERNMENT OF INDIA SCHEME OF POSTMARTIC SCHOLARSHIPS TO SCHEDULED CASTES STUDENTS. Instructions for the applicants: 1. The applicant should fill in correctly the entries from 1 to 14 only. The remaining entries will be filled in by the Head of the Institution where he/she studies. 2. Before filling in the application form, the applicant must carefully read the Regulations of the Scheme. These scholarships are for POSTMatriculation /Post -Secondary studies only. 3. This form is intended for FRESH applicants and for those who were in receipt of scholarship in the previous year but have completed a stage of education (e.g. 10+2). 4. The applicant must submit this application duly completed to the authority prescribed for this purpose by the Government of the State/Union Territory to which he /she actually belongs/permanently settled, before the last date prescribed by that authority for receipt of these applications. Incomplete applications and applications received after the last date of receipt of application is over, are liable to be rejected. The application should NOT be sent to the Government of India. 5. APPLICANT IS WARNED THAT IF HE/SHE SUBMITS THE APPLICATION BY GIVING FALSE STATEMENTS, WRONG DECLARATION OF CASTE, INCOME, ETC., OR OTHERWISE OBTAINS SCHOLARSHIP THROUGH FRAUDULENT MEANS, HE/SHE WILL BE BLACKLISTED, AND DEBARRED FOR SCHOLARSHIP FOREVER UNDER THIS OR ANY OTHER SCHOLARSHIP SCHEME. THE SCHOLARSHIP PAID WILL ALSO BE RECOVERED. PART (A) (Entries to be filled in by the applicant in neat and clear hand writing) ` To The Director of Public Instruction, Applicant Must Applicant must affix his/her U.T., Chandigarh. recent passport size photograph with his/ her signature Sir, I wish to offer myself as a candidate for the award of a scholarship for the year, 200__________ under the above noted scheme. I belong to _________________(SubCaste) and the other particulars are given below:1. Name of the applicant in full (BLOCK LETTERS): ________________________________ 2. Date of birth : ________________________________ 3.(i) Nationality: ________________________________ (ii) State to which the applicant actually belongs/ permanently settled: a) State: b) District: c)Permanent Address: 2 4. Present address: ________________________________ 5. Whether married : ________________________________ 6. State whether your father/husband is alive: Name: ________________________________ Occupation: ________________________________ 7. Give full name, occupation and complete postal address of your father/mother husband/guardian Address: ________________________________ 8. Who supports you in your studies i.e. father/mother/guardian/husband 9. If your father /mother /guardian/husband supports you, please state the total annual income of your parents (father and mother)/ guardian /husband from all sources in preceding year during 31 st March ______ 10.(i) Were you in receipt of scholarship under this Scheme in the previous academic year (ii) If yes, please indicate the course of study and the institution 11. Give particulars of all examinations taken and colleges/ Universities attended commencing with the Matriculation or equivalent examination. Attested copies of the certificates, diplomas, should be attached. Any break in the educational career and how that was spent should be indicated in the remarks column. Where it is not possible to attach a copy of the certificate, an attested copy of the marks sheet be sent: Sr.No. Name of High School/ College/ University/ Board etc. from which examination was taken Date of entering and leaving Name of examination taken Roll No. and year Whether passed or not. If passed, state division Subjects taken Remarks 12.(i) Course of study for which scholarship is now desired by the applicant________________________________ (ii) Name and full address of the educational institution where the applicant is studying the above course.________________________________ (iii) Class to which admitted ________________________________ (iv) Exact date of joining that class ________________________________ (v) Subjects taken ________________________________ (vi) Total number of years required for the completion of the entire course referred to at (i) From To________________________________ (vii) Likely date, month and year in which the final examination will be held and the name of the University/Board which will award the final degree/diploma/certificate________________________________ 3 viii) Whether the course of study is a regular day time / evening time course________________________________ (ix) In case you are studying a regular evening time course indicate how your day time is utilized________________________________ 13. Are you residing in the hostel of the institution or an approved hostel (If yes, give full particulars of the hostel and the hostel dues)________________________________ 14.(i) If you belong to Scheduled Caste, have you attached alongwith this application the Caste Certificate and Income Declaration?________________________________ (ii) Have you attached (a) receipt in acknowledgement of the scholarship amount for the previous academic year, (b) Parent's/ Guardian's Declaration, and (c) Part 'B' from the Head of your Institution with this application________________________________ I hereby declare that I have read the regulations of the Scheme and the statements made by me in this application form are correct. I further agree to abide by the terms and conditions of the award if I am selected for the scholarship applied. I undertake that if any statement made by me is found incorrect by the Government whose decision will be final and binding on me, the scholarship amount received by me or over paid to me will be returned by me and failing which the authority awarding the scholarship will recover the amount through whatever means it deems proper. I fully understand that a declaration of false statements will debar me for scholarship forever under this or any other scholarship scheme. Place: Date: Signature of the Applicant________________________ PARENTS/GUARDIANS DECLARATION (This declaration has to be given by Father/ Mother/Husband /Guardian as the case may be of the applicant). I certify that the particulars given in the application are correct and if any of them is found to be incorrect the Government's decision on whether the declaration of particulars is false shall be final and binding on me. I undertake to refund to the Government, on demand, the entire amount of the scholarship, etc. that may be paid to my son/ daughter/wife/ward failing which the Government may recover the amount from me through whatever means it deems proper. Place: Signature_______________ Date: (Left/Right-hand thumb impression in case he/she is illiterate) 4 PART( B) (To be filled in by the Head of the Institution, where the applicant is studying) (i) The statements made by the applicant in part (A) are correct to the best of my knowledge________________________________ (ii) Character, conduct and attendance of the applicant (general review)________________________________ (iii) Whether you recommend the applicant for the award of a scholarship________________________________ (iv) Date of commencement of the current academic session of the course the applicant is studying in your Institution 1. Date________________________ 2. Course______________________ (v) Date on which the applicant joined the class________________________________ (vi) Likely date, month and year on which the annual examination in the current session will be over________________________________ (vii) (a) Is the applicant exempt from payment of tuition fees (b)If yes, please indicate whether exemption is for full or half tuition fee________________________________ (viii) Details of the nonrefundable compulsory fees (excluding hostel rent and other Incidental charges) payable by the applicant during the current year to the institution________________________________ The applicant is required to pay compulsory fee (excluding hostel rent and other incidental charges) amounting to Rs._________ to this Institution for the current year from _______ to _________ as per details given below: Particulars of all non refundable compulsory fees payable by the applicant Rate Rs. Amount actually payable by the applicant to the Institution Rs. Remarks Tuition Examination Games Library Medical Total: ** Any other compulsory nonrefundable fee payable by the applicant to the institution be indicated here. (ix) Whether the applicant is residing in the hostel or not? If yes, please indicate: (a) the date on which the applicant joined the hostel (b) whether the applicant is entitled to free board and lodging/ free board/ free loading (c) Average monthly charges payable by the applicant : (i) Boarding i.e. mess charges (ii) Lodging i.e. hostel rent etc. (x) Designation and full postal address of the authority/ Head of the Institution to which the scholarship amount, etc. will be sent for disbursement to the applicant (xi) Name of the nearest branch of the State Bank of India or the Government Treasury through which the payment of Scholarship is desired Certified that:( 1) the fees charged from the applicant are compulsorily payable by all students studying in the class and there is no exemption possible. Nor are the fees shown therein reimbursed by the Government or from any other source. (2) This institution is affiliated t o....University/ Board and is recognised by the Government of India/State Government of .....The applicant is studying .... Course in this Institution and the minimum qualification required for admission to that, a course is a pass in the .......examination. (3) The applicant is receiving monthly payment at the rate of Rs. ...per month from the month out of adhoc amount placed at my disposal by the Government No adhoc grant /scholarship has been paid /is being paid to the student as he has failed or been detained in the class and his case has been referred to the awarding authority for decision to avoid wrong payment. (4) The accounts in respect of the applicant, will be regularly rendered to the Government, and in case thee applicant leaves the Institution or otherwise discontinues the studies or accept any other scholarship and the payment of scholarship to the applicant will also be discontinued. The undisbursed amount lying with the Institution on account of scholarship, fees, etc., will also be refunded into the Government account. No. ** Signature of the Head of the Institution Place: Name in Block Letters ______________________ Date: Designation ______________________ **STAMPED SIGNATURES Address ________________________________ WILL NOT BE ACCEPTED Seal of Institution__________________________ CASTE AND CITIZENSHIP CERTIFICATE Notes( i) This certificate is to submitted alongwith the application by only those applicants who belong to the Scheduled Castes. (ii) This certificate should be signed by an officer specially authorised by the Government of the State/ Union Territory to which the applicant actually belongs. (iii) THIS CERTIFICATE IS A VERY IMPORTANT DOCUMENT AND THE SCHOLARSHIP IS AWARDED MAINLY ON THE BASIS OF THIS CERTIFICATE ISSUING AUTHORITY IS THEREFORE ADVISED TO ISSUE THIS CERTIFICATE WITH DUE CAUTION SO THAT THE SCHOLARSHIP REALLY GOES TO THE STUDENT WHO ACTUALLY BELONGS TO EITHER OF CLASSES SPECIFIED ABOVE. I certify to the best of my knowledge that: 1. Shri/Kumari/Shrimati______________________________________son/daug h ter/wife of Shri_____________________resident of ______________ _________________ is a citizen of India and belong to the _________________. 2. His/Her Subcaste is ___________________________and religion is _____________. 3. His/Her father/Guardian /husband is a permanent resident of Village _______________ Tehsil _______________, District _________________, State _______________. 4. The total monthly income from all sources of both the parents/guardian/Husband is Rs._____________. Signature Place: Name in BLOCK LETTERS_______________________ Date: Designation Full Address * A certificate not bearing the seal of the issuing authority if that be a Gazetted or any specially authorized officer, will not be accepted. ** Please write whether the applicant belongs to Scheduled Castes. Specimen form of Declaration of income for purposes of PostMetric Scholarship for Scheduled Castes, Candidates. FORM(A) (To be given by the parents/guardians where the candidate is not employed) Whereas my son/daughter /dependent Shri/Kumari Student of ______________________________________College has applied for grant of Scholarship, I, Shri ______________________________son of Shri (Address) _____________________________________________________________decl are that my total annual income from all sources in the preceding year ending 31 st March, _____ was Rs.__________as per details furnished below. I also affirm that particulars of property held by me are as shown below and that I have correctly indicated the amount of various cases and land revenue paid by me. I make myself personally responsible for the accuracy of the facts and figures furnished. I further undertake that in the event of particulars given in this declaration being found to be false, I shall refund to the President of India the whole amount of the Scholarship paid to the said _________________________________________________and the Government decision on whether the declaration of particulars is false shall be final and binding on me. Place_____________ __________________ Date______________ (Signature)