Scholarship Application Form

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SCHOLARSHIP APPLICATION FORM
Academic Year
Application Date
College Name
Course Name
Student SSC details
SSC Board
Passing Year
SSC Seat Number
Marks Obtained
Applicant Details
Applicant Name
Mother’s Name
Date of Birth
Is Resident of Maharashtra
YES / NO
Caste Category
Caste
Sub Caste
Gender
Orphan
YES / NO
Disabled
Is Applicant Salaried
YES / NO
Applicant’s Annual income
Total Annual Income
Marital Status
Student Prequalifying Details
Last attended School/College/Institute
Last Exam Passed
Last Exam Passes Year
Last Exam Marks
SCHOLARSHIP APPLICATION FORM
Academic Year
Application Date
College Name
Course Name
Student SSC details
SSC Board
Passing Year
SSC Seat Number
Marks Obtained
Applicant Details
Applicant Name
Mother’s Name
Date of Birth
Is Resident of Maharashtra
YES / NO
Caste Category
Caste
Sub Caste
Gender
Orphan
YES / NO
Disabled
Is Applicant Salaried
YES / NO
Applicant’s Annual income
Total Annual Income
Marital Status
Student Prequalifying Details
Last attended School/College/Institute
Last Exam Passed
Last Exam Passes Year
Last Exam Marks
Institution Details
Subject
College Admission Number
Date of Admission
Joining Date
Is Fee Paid?
YES /NO
Fee Receipt Number
Receipt Date
Fee Amount Paid
Quota
Management / Government
Is studying at night School?
YES / NO
Bank Account Details
Bank Name
Branch Name
Account Number
Contact Details
Telephone Number
Mobile Number
Email Address
Address for Correspondence
Pin-code
Taluka
District
Parent /Guardian Details
Name
Relation with applicant
Profession
Annual Income
Hostel Details
Name of the Hostel
Hostel Admission Date
Hostel Type
Is Mess Service Available
YES / NO
Rent per Month
Hostel Address
Pin-code
Taluka
District
Hostel Contact Details
Telephone Number
Mobile Number
Email Address
Documents
Caste Certificate Number
Issuing Office
Caste Validity Certificate Number
Scrutiny Committee
Income Certificate Number
Date of Issue
University Registration Number
DECLARATION
The information furnished by me is complete and correct. I bear the complete responsibility for all the
above information provided.
Applicant’s Signature
Parent’s Signature
Principal’s Signature

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