Fresh Continuing Renewal
Name (In BLOCK LETTERS)
Department Roll Number
Gender Programme Semester
Contact No E-Mail
Particulars of academic qualification starting with matriculation
a. For Freshers
Exam
Passed
Year of
Passing
Board/
University
CGPA % of Marks
b. For Continuing Student/Renewal Cases (Old Students)
Last
Semester
Passed
Year of
Passing
CGPA % of Marks
Any disciplinary action taken in the preceding period (Y/N)
Do you hold a scholarship before? If yes, please give details
Annual income as per the income certificate
Any other relevant information that you wish to furnish
Signature of the Candidate
Place Date
Remarks by the HoD
Head of the Department with seal
Documents to be submitted
1. Slef attested copies of Marksheet qualifying exam/Last Semester
2. Original Income Certificate issued by an officer not below the rank of BDO/Tahsildar
Note: The certificate issued by Panchayat office/Muncipality Chairman/MLA etc will not be entertained
APPLICATION FORM FOR MERIT-cum-MEANS SCHOLARSHIP for UG and PG
(To be submitted to the office of the DSW on or before 17th of October 2019)
Certified that the statement made by me in this form is correct. I declare that if Iam selected for the scholarship I
shall devote my full time to the course of study and that I shall not receive any other scholarship from any other
sources
