Application form for the grant of Pre-Matric Scholarship for the students belonging to Schedule Caste and other Backward Classes to awarded by the Social Welfare Department for the year_______________________. 1. Name of the applicant_____________________________________________ 2. Father/Guardian's Name___________________________________________ 3. Whether Orphan_________________________________________________ 4. Whether Schedule Castes or Other backward Classes____________________ ______________________________________________________________. 5. Sub-Centre__________________________________________________. 6. Residence______________________________________________________ 7. Class in which reading____________________________________________ 8. Name of the Institution/School______________________________________ 9. Last examination passed indicating the year ___________________________ 10. Marks Obtained (State distinction if any) _____________________________ 11. Parent's / Guardian's income _______________________________________ 12. Financial assistance received during the current year or the last indicating the name of the Deptt. _______________________________________________ 13. Remarks of the head of the Institution ________________________________ ______________________________________________________________. INCOME CERTIFICATE Certified that the monthly income of Shri. ____________________________ R/o _________________________ Father / Guardian of _________________ ____________________________ Class of ___________________________ School is Rs. _________________________________ this has been issued under my head and seal. Signature of the Headmaster/ Principal Signature and Seal of the Tehsildar/T.D.O. Head of the Institution (Gazetted). Verification by: 1. Social Welfare Officer: 2. District Social Welfare Officer:
