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THE WORLD ZOROASTRIAN ORGANISATION TRUST

Registration no. E/1323 – Valsad 30.05.1991

Registered Address: WZO Senior Citizens Centre, Pinjar Street, Malesar, Navsari 396 445.

Please reply to:

C-1, Hermes House, 3rd Floor, Mama Parmanand Marg, Opera House, Mumbai 400 004. India.

Tel No. 91-22- 23684452; 91-22- 23684453

E-mail: ,

Application Form for Assistance towards

Higher Education in India

Applicants are advised to note the following: -

Ø  WZO Trust acts only as a facilitating agency and recommends cases to donors. Funds are transmitted to applicants only if the donors remit the same through WZO Trust. Donors decide the appeals they wish to support and the quantum. If response is not received within three months, it should be assumed that donor support has not been forthcoming.

Ø  Please attach copies of Receipts of education fees paid and other documents asked for in this application.

Ø  Please complete the form in all respects; all items must be filled in. Incomplete forms will be rejected and filed without any further intimation to the applicant.

1.  Applicant’s Full Name:

2.  Present Address:

3.  Home Town Address:

4.  Date of Birth:

5.  Age:

6.  Telephone / Mobile No.:

7.  E-Mail Address:

8.  Qualifications:

List chronologically secondary/ high schools attended over the past four years.

(copies of Mark Sheets / Certificates to be enclosed)

Name of School/College / Location / Month & year of passing / Qualification

9.  Family Details:

(copies of Salary Certificate/ Income Tax Returns to be enclosed)

Name of family members / Age / Relationship
with applicant / Occupation / Monthly income/ earning

10. Monthly income from other sources

(i.e. Interest/ Dividends/Income from property, etc):

11. Total Family Income per month:

12. Status of applications submitted to other Trusts/Institutions/Donors:

(List names of all Trusts etc you have applied to for scholarships/ grants and the amount committed)

Name of Trust/ Fund/ Institution/ Donor / Application submitted on / Amount Sanctioned

(Attach additional sheet if necessary)

13. Details of proposed course of studies in India:

a)  Proposed Course of Studies in India:

b)  Name & Address of School/College in India:

c)  Cost of Course: Rs.

d)  Total duration of Course:

e)  State whether admitted to the Course and if so, please attach relevant documentation:

f)  Amount to be contributed by applicant, parents, guardians, relatives: Rs.

14. Other Remarks:

(You may include any special circumstances that you feel should be taken into consideration when reviewing your application)

It is understood that if any assistance is extended will be in the form of a LOAN, I (applicant) and my parents guarantee to repay the loan, once I have completed the Course and been employed.

Applicant’s Signature: ______

Date: ______

Parents’ Signatures: ______

______

Date: ______

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