Download Application Form for Merit-cum-Means based Scholarship for Students belonging to Minority

GOVERNMENT OF MANIPUR SECRETARIAT: WELFARE OF MINORTIES & OTHER BACKWARD CLASSES DEPARTMENT. NOTICE Imphal, the 25th August 2007. No.1/1/2007/DMOBC:-It is hereby notified for general information that the Ministry of Minority Affairs, Government of India has introduced a Scheme of Merit-cum Means based Scholarship for students belonging to the minority communities (Muslims and Christians) for Technical and Professional Courses at under-graduate and post-graduate levels which is a centrally sponsored scheme, funded entirely by the Central Government and will be implemented through the State Government's administrations during the Eleventh Five Year Plan beginning 2007-08. Therefore, the Department for Welfare of Minorities & Other Backward Classes, Manipur invites applications for award of the abovementioned Scholarship in the prescribed format from the intending students belonging to Minority Christians and Muslim communities domiciled in the State of Manipur. Application Forms can be had from the Directorate of Welfare of Minorities & Other Backward Classes, Manipur on all working days and forms can also downloaded from the web site, http:// Manipur.nic.in/Mobc.htm. Duly filled in application forms should be submitted to the Director, Welfare of Minorities & Other Backward Classes, Govt. of Manipur. Last date for submission of application forms is on 15th September, 2007. The following is the eligibility criteria for applying the scholarship:­ (i) Students, who have got admission in a recognized college to pursue technical/professional courses, on the basis of a competitive examination. (ii) Students, who have got admission in a recognized college to pursue technical/professional courses, without facing any examination, will also be eligible for scholarship. However, such students should secure not less that 50% marks at higher secondary/graduation level. (iii) Selection of students will strictly be done on merit. (iv) A scholarship holder under this scheme will not avail any other scholarship/stipend for pursuing the course. (v The annual family income of the beneficiary/parents or guardian of the beneficiary should not exceed Rs. 2.50 lakh per annum from all sources. (vi) A students residing in a particular State/UT will be entitled for scholarship under the quota of that State/UT only irrespective of his place of study. (vii) Continuation of the scholarship in subsequent years will depend on successful completion of the course during the preceding year. (viii) 30% of scholarship will be reserved for girls students of each which is transferable to male students in the case of non-availability of female candidates. (ix) The Scholarship will not be paid for the period of internship/housemanship in the case of MBBS course or for a practical training in other course if the student is in receipt of some remuneration during the internship period or some allowance/stipend during the practical training on other course. (x) The rate of the scholarship is as under:­ Sl. No. Type of Financial Assistance Rate for Hostler Rate for Day Scholar 1. Maintenance Allowance (For 10 months only) Rs. 10,000/­per annum (Rs. 1,000/-p.m.) Rs.5,000/­per annum (Rs. 500/-p.m.) 2. Course Fee Rs. 20,000/-per annum or actual whichever is less Rs. 20,000/-per annum or Actual whichever is less Total Rs. 30,000/- Rs. 25,000/­ (Kh. Dineshchandra Singh) Director Minorities & Other Backward Classes, Manipur. Memo. No. 21/1/2007-MOBC Imphal, the 25th August, 2007. Copy to: ­ (i) The A. P.S. to Minister (MOBC), Manipur (ii) The P.S. to Chief Secretary, Government of Manipur (iii) The Director, Information & Public Relations, Government of Manipur. for favour of necessary publication in the media. (iv) The State Informatics Officer, NIC, State Unit, Secretariat, Imphal.. He is requested to kindly upload the Notice and the application format etc in the official website of this Department at the earliest. (v). The News Editor, DDK Imphal for kind announcement as news item in the News Bulletin of DDK, Imphal. (vi) The Assistant News Editor, AIR, Imphal for kind announcement as news item. (vii) The News Editor, ISTV Imphal for kind announcement as news Item. (viii) The Editor, _____________________________with a request for publication as News Item in your esteem News Paper. (Kh. Dineshchandra Singh) Director, Minorities & Other Backward Classes, Manipur. FORMAT OF APPLICATION FOR OFFICIAL USE ONLY: Sl.No. of application Year Course Whether approved Affix a self attested passport size photograph. 1. Full Name (in block letters): 2. Father's name/husband's name: 3. Mother's Name: 4. Domicile State/UT (State/UT which the student belongs to): 5. Address for correspondence: 6. Permanent address (please enclose residential certificate from concerned State Government authority): 7. Date of Birth (please enclose certificate): 8. Whether male or female: House No. Mohalla/Street City/Town/ Village & P.O. District State Pin Code House No. Mohalla/Street City/Town/Village & P.O. District State Pin Code D D M M Y Y Y Y Male Female 9. Religion: 10. Nationality: 11. Details of educational qualifications from matriculation/SSLC/SSC onwards (please enclose certificates attested by a gazetted officer) 12. Details of Course for which scholarship is being sought: (i) Name of the technical/professional course: ................. (ii) Duration of course: ....................... (iii) Academic year: ......... 13. Basis of admission in professional/technical course (whether on the basis of qualifying competitive examination or on other grounds. Please give details): Examination passed University/Board/ Institution/Council of Examination Main subjects Year of passing %of marks Division / Class / Grade 14. Details of Collage/Institution: (i) Name of the Collage/Institution where admitted : (ii) Address of Collage/Institution : (iii) Telephone No : (iv) Fax No. : (v) E-mail address : (vi) Is the Collage/Institution recognized? If so the name of authority which has recognized the Institution : (vii) To which University is it affiliated/ does it have Deemed University status : 15. For renewal of Scholarship: 16. Total Annual Course fee: Rs. ..... Name of Examination passed Year Marks obtained Full marks % of marks (Break up of course fee such as tuition fee, library fee, examination fee etc. other than refundable deposits) Sl. No. Item Annual fee Total 17. Details of Bank Account of student: (i) Name of the payee (as in the bank accounts) ................ (ii) Name of the Bank: ........................... (iii) Bank Branch (full address) ...................... .. .........................State .......... (iv) District .................. Pin No. ....... (v) Branch Code No. ..... (vi) Bank Account No. ....... (in words .............) (vii) Type of Bank Account ....... Saving/Current. (viii) MI CR code of the Bank ........ (ix) Mode of Electronic transfer available in the Bank ..... ECS/RTGS/NEFT/CBS/code number (if any) 18. Annual Income of parents/guardian of the student: Rs. ....... (Specimen form of declaration of annual income is given at Annexure-II, which is to be signed by the parent/guardian of the student and enclosed alongwith the application. In case parent/guardian is employed, income certificate from employer may also be enclosed). 19. Documents enclosed with the application: (i) One copy of passport size photograph with signature. (ii) Attested certificates of Educational qualification as filled up in para 11. (iii) Income declaration - affidavit on Non-Judicial Stamp paper and Income Certificate from the employer. (iv) Proof of permanent residence. (v) Receipt in acknowledgement of Scholarship in the previous year duly countersigned by the Head of the Institution. 20. Declaration: (i) I hereby declare that the information given above is correct. (ii) I am not availing any other Scholarship for this purpose from any other sources. (iii) I shall abide be the terms and conditions for sanction of the Merit-cum-Means Based Scholarship. (iv) I undertake, that if any stage, it is found to the satisfaction of the sanctioning authority in the Ministry of Minority Affairs that the information given by me is false or if I violate the terms and conditions of the Scholarship, the Scholarship sanctioned to me, may be cancelled and the entire amount of Scholarship will be refunded be me or recovered from me, apart from liability for such penal action as warranted by Law. Date: Palce: Signature of the Candidate: 21. Verification/information to be furnished by the Head of Institution/College: It is certified that the information filled in the above mentioned columns by Shri/Smt/Kumari ________________________________________________________ S/o,D/o,W/o, Shri __________________________________________ who is admitted in ___________ Course for the academic session ________ in _________________ ______________________________________________________ College is correct. He/She is a Hostler/Day Scholar of the College. It is certified that the above mentioned student has passed the ______________ Examination for ____________ (year) and has attained ___________ % of marks. It is also certified that the student has not changed the Course of study and or the Institution of the study for which the Scholarship was originally awarded/ has changed the course of study and/or Institution with prior approval of the State Government (please strike out whichever is not applicable). Details of Bank Account of Institution/Collage (for deposit of Course fee). (i) Name of the payee (as in the bank accounts) ................. (ii) Name of the Bank: ............................ (iii) Bank Branch (full address) ......................... ......................State ............. (iv) District ............. Pin No. ....... (v) Branch Code No. ............ (vi) Bank Account No. ....... (in words .................. ......................................) (vii) Type of Bank Account .......... Saving/Current. MI CR code of the Bank ........ (viii) Mode of Electronic transfer available in the Bank ..... ECS/RTGS/NEFT/CBS/code number (if any) Date: Place: Signature of Head of the Institution/College (with official seal). FORMAT FOR DECLARATION OF FAMILY INCOME: (On Non - Judicial Stamp Paper) I..............................(Father/Mother/G uardian) of ....................... ( name of student ) who is studying in ................ Hereby declare that my annual income from all sources is Rs. ......( Rupees ........) only. I further declare that the statement made by me and my ward in this application form is true and correct to the best of my knowledge & belief. I am aware that if there are false statements/information in the foregoing application I or my ward is liable to be prosecuted under the Indian Penal Code for forgery in addition to other penal consequences. I further agree to abide by the terms and conditions of the Merit cum means based Scholarship Scheme if selected and the entire amount of financial assistance can be recovered from me in case the above information is found fully or partially incorrect. Signature, Date: (Father/Mother/Guardian) Residential Address. PROCEDURE FOR APPLYING THE SCHOLARSHIP:- The application for scholarship should comprise:­ (i) One copy of the application for scholarship in the prescribed form (separate application forms prescribed for "fresh" and renewal of scholarship by the concerned States. (ii) One copy of the passport size photograph with signatures of the students thereon (for fresh scholarship). (iii) One attested copy of certificates, diploma, degree etc. in respect of all examinations passed. (iv) An income declaration by the self-employed parents/guardians, stating definite income from all sources by way of an affidavit on non-judicial stamp paper. Employed parents/guardians are required to obtain income certificate from their employer and for any additional income from other sources, they would furnish declaration by way of an affidavit on non-judicial stamp paper. (v) Proof of permanent residence. (vi) The scholarship is depended on the satisfactory progress and conduct of the scholar. If it is reported by the Head of the Institution at any time that a scholar has by reasons of his/her own act of default failed to make satisfactory progress or has been guilty of misconduct such as resorting to or participating in strikes, irregularity in attendance without the permission of the authorities concerned etc. the authority sanctioning the scholarship may either cancelled the scholarship or stop or withhold further payment for such period as it may think fit. (vii) If a student is found to have obtained a scholarship by false statement, his/her scholarship will be cancelled forthwith and the amount of the scholarship paid will be recovered, at the discretion of the concerned State Government. The students concerned will be blacklisted and debarred for scholarship in any scheme forever. (viii) A scholarship awarded may be cancelled if the scholar changes the subject of the course of study for which the scholarship was originally awarded or changes the Institution of study, without prior approval of the State Government. The Head of the Institution shall report such cases to them and stop payment of the scholarship money. The amount already paid may also be recovered at the discretion of the State Government. (ix) A scholar is liable to refund the scholarship amount at the discretion of the State Government, if during the course of the year, the studies for which the scholarship has been awarded, is discontinued by him/her. (x) The regulations can be changed at anytime at the discretion of the Government of India. (xi) The Quota of the Scholarship for the State of Manipur is 20 (twenty) for Muslim Students and 78 (seventy-eight) for Christian students.