APPLICATION FORM FOR STATE SCHOLARSHIP OF GOVERNMENT OF ANDHRA PRADESH Batch and Index No. (i) Each item should be read carefully before the Form is filled in No., change will be permitted after the application has been submitted. If any entry is found Affix recent passport size Photo graph duly attested by the Institution to be incorrect the duly attested by the Institution where Scholarship if awarded will be where the Scholar is the Scholar is now studying at the time now studying liable to be cancelled forthwith. of submission of application (ii) A recent pass-port size photo should be fixed at the space specified. (iii) Incomplete application received after the Prescribed date is liable for rejection. (iv) The application Form shall be submitted to the Commissioner of Collegiate Education, Government of Andhra Pradesh, Hyderabad-500 001 through the concerned Principal where the candidate is prosecuting his/her further course of studies/after passing first Degree Examination. 1. Name in full (in Block letters) : . . 2 (a) Date of birth (in Christian era) : . . (b) Place, District and State of birth: . . 3. Whether the scholar is in full time employment (if so, details should be furnished); . . (a) Name in full : . . (b) Present Postal Address; . . (c) Permanent home address; . . (d) Profession stating designation (if any) and address: 5. Whether the scholar is a citizen of India: . . 6. Total monthly income from all sources of both parent or scholar in the preceding year of the award. In the case of salaried person, Basic pay and Allowances should be shown seperately and Statement of deductions also be shown separately: . . Note :- (1) For Post-Graduate Studies of 1st Degree level i.e., BL/LLB/BED. etc., the Scholarship will be Governed by means test i.e., depending on parental Income from all sources which should not exceed Rs.500/-p.m., or Rs.6,000/- per annum. (2) In case of Government Employees the educations Statements may be furnished separately. (3) The Index No. given on the top of this application should be quoted in all future correspondence including the renewals . (4) Intermediate Marks Sheet/Degree Examination Marks Sheet may be enclosed (5) An Income Affidavit shall be submitted alongwith this Form in the proforms enclosed. (6) For Post-Graduate courses the Scholarship will be paid without any consideration of the income and for which there is no need to furnish income certificate. PARTICULARS OF COLLEGE/INSTITUTION LAST ATTENDED Name of the College/Institution Date of entering Date of Leaving Yr. Remarks if any 7. (i) Name of the Examination passed in April/May. 1989. . . (ii) Name of the authority (Board or University) which conducted the examination taken by the applicant. . . (iii) Roll No. of the applicant : . . Subjects including language Maximum marks Marks obtained Class or Division (iv) Subjects (including Languages) taken at the Examination held in 1986 with maximum marks alloted to each subject (Copy of memorandum of marks attested by the Gazetted Officer has to be enclosed. (v) Percentage of marks obtained in the aggregate: . . (vi) Rank Secured at the Examination: . . (i) (ii) Name of the Institution where Admission has been secured daring the academic Year 1989-90: Name of the course of study undertaken, subject offered and the duration of the course: . . . . 9. (a) Whether the applicant is in receipt of any other shcolarship or scholarships from Central Government or State Government or any other institution, particular should be given including the monthly rate and from which the scholarship/stipend is being drawn; . . (b) Whether the scholar is in receipt of any freeship/free educationship/bursary granted by the Universities/colleges . . Note :-The scholar can enjoy the fee concession if any granted under Educational Rules, Hindi Scholarship Telugu Vignana Parithoshikam and S.C. and S.T. Scholarship in addition along with the State Merit Scholarship. 10. Certified that the Statement and entries made by me in this application Form are correct. I declare that in case I am selected for the scholarship applied for I shall devote my full time to the course of study and that shall not receive any other scholarship/stipend fro any other source. I also declare that /I shall not participate in strikes, and indulge in activities subversive of discipline or public peace and order. I also declare that the Government is at liberty to take such action as it deemed fit, if any behavior found to be not satisfactory during my course of study and it should be binding on me. Signature of Applicant. Signature of Parent/Guardian. JOINING REPORT (TO BE FILLED IN BY THE HEAD OF THE INSTITUTION) Certified that the particulars furnished by the candidate wherever necessary have been verified with reference to the Original records available in my office and found to be correct and that the candidate have been granted admission as a regular full time student in this institution for ..............................................course First/Second /Third/Fourth /Fifth year class with effect from that the (Date) (Month) (Year) Place : Signature of the Principal Date : with Office Seal and full address. Spl.Note:- The Joining report should be filled in care fully giving full particulars there in.
