ODISHA STEVEDORS LTDSCHOLARSHIPS
Vikash Educational CharitableTrust
Nurturing Excellence amongStudents
Application for Renewal of Scholarships for the Year2016-17 (To be filled in by the student’s and sent by 30th Oct, 2016
1.Name:……………………………………………………………………………………………….M/F………MobileNo:………………………………………………
2.Name of the College:…………………………………………………………………………………………..
Course:………………………………Branch:………………………………………………
Name of the Principal:………………………………………………………….Phone No:..………………….Year……………... Semester:……………………….. University Rgn.No./RollNo………………………
3.Whetherpassedallsubjectsduringthelastyearinfull:………….Yes/No(tickone)
If No, explain indetail:………………………………………………………………………………………………………..
4.Father’s Name:………………………………………………Occupation:………………………….. MobNo……………......
5.Mother’s Name:……………………………………..Occupation:…………..……………………. MobNo………….………………………
6.Brothers and SistersInformation:
Sl.No / Name / Age / Occupation/Class ofStudy / School/College7.Gross family income perannum:………………………………
8.Scholarships/Financial assistance received tilldate:
Name oforganization / Year / AmountRs. / Remarks9.HaveyouappliedforstudyloantoanyBank?………………………………………………………....Ifyes,thengivedetailslike nameandaddress,phoneNo.oftheBank,dateofapplicationandpresentstatusofyourapplication.
…………………………………………………………………...
………………………………………………………………………………………………………………………
10. If sanctioned, giveamount:………………………………………………………………………………..
11.Estimate of Expenses for the Current AcademicYear:
Items ofexpenses / Estimated expensesRs. / Expenses incurred till dateRs.AdmissionFees
TutionFees
University Regn.Fees
Hostel Fees(SeatRent)
MessingExp
Transportation
Books 7stationery
Others(specify)
12. Bank Account No:……………………………………………………………………………………………..Name and Address of theBank:….…………………………………………………………………………
13.Address: (in capital letters):
PresentAddress / PermanentAddressPIN: / PIN:
ContactNo: / ContactNo:
E‐MailAddress: / E‐MailAddress:
(ApplicationsofDiploma/DegreeEngg.andMBBSstudentswillnotbeconsideredwithoutcorrecte‐mailid)
14.DeclarationbytheStudent:Iherebydeclarethattheinformationgivenaboveinthisapplicationistrueandcorrectto thebestofmyknowledgeandbelief.IalsopledgethatuponcompletionofmystudyIshallreturntheamountofassistancereceivedthroughtheTrust,within5yearswhichwillbeusedassimilarassistancetootherneedyandmeritoriousstudents.
…………………………………… / ……………………………………….. / ………………………………………Name of theApplicant / Signature ofApplicant / Date
(in Capitalletter)
15.DeclarationbytheParent/Guardian:IherebydeclarethattheinformationgivenbymySon/Daughter/Wardistrue andcorrect.Ipromisetopersuademywardtoreturntheassistanceintime.Ifhe/shefailstoreturn,Iwillreturn the amount
……………………………………. / ………………………………………….. / ……………………………………Name ofParent / Signature ofApplicant / Date
(in capitalletter)
16.CertificatebytheCollegeAuthorities:CertifiedthatSri/Kum……………………………………………………..isastudentofour college and is now studying in………………………………………………………………………………………………………………………………………Ifhe/sheisgettinganyotherassistance,pleasementionthesourceandamount.
17.Any othercomment.
Signature (With collegeseal): Name:……………………………………………………………Designation:………………………………………………………Date:…………………
Important:Followingdocumentsmustbeattached;otherwisetheapplicationwillberejected.1.Copies of Mark Sheets of all Semesters of LastYear.
2.Copies of Receipts of Tution Fees and Hostel Fees paid during theyear.
3.AletteraddressedtotheDonor,givingdetailsofactivitiesinthecollegeduringpast6monthsinminimum200words
4.For final Year Students, the mark sheets, pass certificate with latest postal & E‐mail address are to besentafter completion of theirstudy.
Address forCommunication:
VIKASH EDUCATIONAL CHARITABLETRUST