GAME: _________________ For Office Use only Recommended for State Level Sports Talent Search Scholarship. Amount Rs. ______________ Position. ________________ 1.Member 2.Member 3.Member 4. Member 5. Member (Sports Talent Scholarship Screening Committee, Sports Department, U.T, CHD) Application form for the grant of the Sport Talent Search Scholarship Name of the School/College: ____________________ Sports Performance 1st position in Junior/Sub-Junior National Championship, Mini National Championship, Inter College, Senior, Junior & Junior & Sub Junior State Championship, Inter College Tournament conducted by P.U And U.T State School Tournament Senior and Junior. 1. Name of the Candidate (In Block letter) __________________________________________ 2. Father's Name: ______________________________________________________________ 3. Sex: _____________________ Height _____________ Weight _______________________ 4. Date of Birth: _________________ Place of Birth: _________________________________ 5. Father/Guardian's Profession: __________________________________________________ 6. Full Residential Address with Telephone No(if any) _________________________________ ___________________________________________________________________________ 7. Citizenship of Father/Guardian: _________________________________________________ Attested copy of photograph 8. Academic Qualification/Achievement: _____________________________________ 9. (a) Class in which studying: ______________________________________________ (b) Name of School/College attended ______________________________________ (c) Date of joining in School/College ______________________________________ (d) Percentage of attendance up to date _____________________________________ 10. Are you in receipt of any other Sports Scholarship ____________________________ a. Source of Scholarship ____________________________________________ b. Duration of Scholarship ___________________________________________ 11. Whether the Candidate is belong to SC/ST __________________________________ 12. Sports Particulars or Achievement for the year of 2002-2003 ( 1/4/2002 to 31/3/2003): 1. ____________________ 2. ____________________ 3. _____________________ DECLARATION Certified that the information made by in this application are correct. I declare that in case I am selected for scholarship for, I shall devote my full attention towards attaining high-class proficiency in Sports and that I shall abide the terms and conditions of Scholarship. Signature of Applicant; _________________________ Signature of Father /Guardian: ___________________ 1. VERIFICATION FOR STUDENT: - Certified that ______________________Son/Daughter of Sh _________________ is/was bonafide regular student of (Name of School/College/University) _____________________ and is studying at present in __________________ Class for academic year _____________ and information supplied in application is form is correct. 2. Certified that the Date of Birth of the Applicant is ___________________________________ in words ________________________________________________________________________. 3. Certified that the Candidate bears a good moral character. Signature of Head of Department (With seal) Verification: - 1. Certified that____________________ has attained first position for the year ________________. 2. Certified that the Candidate bears a good moral character. 3. It is further certified that the Association is duly Recognized and Affiliated with the National Federation. Signature of President Hony. Secretary of the Association (with Seal) Note:- Please attach copies of your certificates of sports during the year 2002-2003 duly attested by the Principal of the Institution. Application will not be entertained without sports certificates. Games should be recognized by the concerned Federation and State Olympic Association. No application form will be entertained after due date 31/8/2003.
