Form No. HS. I Grant -In-Aid Scheme of Scholarships To Students From GOVERNMENT OF MANIPUR Non-Hindi Speaking States For Post Matric/Post UNIVERSITY & HIGHER EDUCATION DEPARTMENT Graduate/Ph.D. Studies in Hindi ( FR E S H ) Not to be filled in by student of Institution (for use of State/Government Head of Voluntary Hindi Organisation) Category No. ...... Sl. No. of application.......... % of Marks in Hindi ..... % of Marks in Aggregate ..... Passport size photograph(with signature of the Principal) S t a t e m e n t o f P a r t i c u l a r s 1. Name of the Candidate in Full : .............. 2. Full address at which communication should be sent to the student(in block letters) : .............. 3. Place of Birth ............... District ....... State ....... 4. Date of Birth : ............. 5. Permanent address in full : ............. 6. Place where you have resided during last five years : ............. Address Period District ....... State ....... ................ From .....To..... 7. (a) Father's/Guardian's Name in full : ............. (Guardian name if father is not alive) (b) Nationality : ............. (c) State to which he/she belongs : ............. (d) Occupation : ............. (e) Present address : ............. (f) Permanent address : ............. 8. State to which you belong : ............. 9. Mother tongue (please give the name of Major : ............. Language and not the dialects) 10. (a) Are you employed anywhere ? : ............. (b) Are you preparing simultaneously for any two : ............. course? If so, give details indicating whether Hindi is a subject of study in both these courses. 11. (a) Name of the Institution where you have secured admission during the current Academic year: ... ................................. (b) Name of the course joined by you in the current academic year : ......... (c) Name of the Examination next below i.e. Examination the passing of which in the minimum qualification for admission to the course mentioned in 12 (b) : ............ (d) Did you pass the Examination next below with Hindi as a subject? If not, have you passed another Examination in Hindi equivalent to examination next below, if so, mention the name of the Examination. : (e) Year and month in which the examination next below was held : ........... ( 2 ) (f) In how many attempts did you pass the examination next below : ............ (g) Whether you have been taken Hindi as a main/subsidiary/Optional subject in the course of studies now joined by you? If so, mention the number of years for which you are required to study Hindi in this course : .............. 12. (a) Particulars of all examinations passed commencing from Matriculation or an equivalent examination (write in chronological order). (b) Whether Hindi was a subject in the examination (please say yes or no) : ............ 13. List of documents attached. The reasons for the absence of any documents must be clearly stated. Original documents should not be responsible for their loss. Only copies attested by the Head of the Institution or any Gazetted Officer should be attached. Name of Examination Name of the University/ Board Vol. Hindi Organisation Period during which he studies in particular class Year & month in which the exam. was held Class or Division with P.C. of marks No. of attempt made in passing the examination Aggregate Hindi N.B.: A Certified copy of the marks sheet in respect of the Matriculation/equivalent/I.A/PreUniversity/Master's Examination whichever the candidate has passed at the end of last academic year must be attached. If not readily available, it should follow as soon as possible otherwise application will not be considered. The mark sheet of all the parts or year of the course must be attached. 14. I hereby declare that I have read the Rules of the Scheme and the statements made by me in this application form are true to the best of my knowledge and belief. I further agree to abide by the terms and conditions of the award if I am collected for scholarship applied for. Dated P.O. Place District Signature of the student. 15. (to be filled up by the Head of the Institutions in which the student has secured admission in the current academic year). (a) Name of the University/Voluntary Hindi Organisation to which the Institutions joined by the student is affiliated. : ............................... (b) Does the University to which your college is affiliated conduct the M.A. (Hindi) Examination, (To be sponsored only in the case of students studying in B.A./B.Sc./B.Com. course): Yes/No (c) In case the answer to (b) above is 'Yes' please indicate whether the student will be eligible for admission to M.A. (Hindi) Course of the same University after passing his/her B.A./B.Sc./ B.Com. Yes/No (d) Is your college an evening college? If so, is the student employed anywhere? Yes/No Note:-INAPPLICABLE PORTIONS MUST BE DELECTED OTHERWISE APPLICATION IS LIABLE TO BE REJECTED. ( 3 ) Certified that Shri/Smt/Km.............................................. was admitted into my institution during the current academic year as a regular and full time student on ...... ........ (date)........... year to........... class. The information given by him/her is correct to the best of my knowledge and belief. Place: Signature of the Head of the Institution. Date: Name of the Head of Institution Seal of the Institution Seal 16. Applicable to candidates who are in service and awarded scholarship sponsored by the State Government of Manipur for higher studies in Hindi and who is willing on completion of the course to be employed in a post where knowledge and use of Hindi in considered essential. Dated : Signature of sponsoring Authority Place : Seal.
