APPLICATION FOR GOVERNMENT OF MEGHALAYA'S STATE MERIT JUNIOR/SENIOR/POST-GRADUATE SCHOLARSHIP I. APPLICATION MUST BE SUBMITTED THROUGH THE HEAD OF THE INSTITUTION JOINED BY HIS/HER II. THE APPLICATION (SUBMITTED THROUGH THE HEAD OF THE INSTITUTION) SHOULD REACH THE OFFICE OF THE DIRECTOR OF HIGHER AND TECHNICAL EDUCATION MEGHALAYA, SHILLONG WITHIN THE STIPULATED TIME. Passport Size Photograph to be pasted here Name of the applicant in full Shri/Smti/Kum _________________________________________ (in Block Capital Letter) (a) Present address in full Village/Town ________________ P.O _________________ District ____________________ State _________________ (b) Permanent address in full Village/Town _________________ P.O ________________ District ____________________ State _________________ (c) Exact date of Birth(in Christian era) ______________________________________________ 1. Father's name in full ____________ Shri _____________________________________________ (a) Present address in full Village/Town _________________ P.O ________________ District ____________________ State _________________ (b) Permanent address in full Village/Town _______________ P.O __________________ District ____________________ State _________________ (c) Profession stating designation (if any) _____________________________________________ and address in full _________________________________________________ 2. If Father is not alive, the guardian's name Shri/Smti/Kum ________________________________ in full (a) Present address in full Village/Town ___________________ P.O __________________ District ____________________ State _________________ (b) Permanent address in full Village/Town _______________ P.O __________________ District ____________________ State _________________ (c) Profession stating designation (if any) _____________________________________________ and address in full _________________________________________________ 3. Particulars of School/Colleges/Institutions last attended:- (a) Name of the School/ College last attended _________________________________________ (b) Date of entry (with Class) ______________________________________________________ (c) Date of leaving ___________________________________________ 4. Did a candidate migrate or was transferred ____________________________________________ from one Institution to another within the prescribed course of study? If yes, please indicate :-- (i) Transferred from ____________________________________________ (School/Colleges) with effect from ________________________ and admitted in ______________________ _______________________ (School/College) with effect from ______________________ (ii) State the reason of migration or transfer from one Institution to another _______________ (iii) Did the transfer from one institution to another, is authorized by the Inspector of Schools or any Competent Authority? _________________________________________________ If yes, please furnish below the Memo. No. and date of the Orders which the transfer is authorized by the competent Authority: 5. Particulars of the University/Board Examination: (a) Name of the last examination passed ______________________________________________ (b) Year of passing _______________________________________________________________ (c) Name of the Institution from which appeared in the examination and passed (d) Name of the University/Board which ______________________________________________ conducted the examination taken by the candidate (e) Roll No. of the candidate in the University/ Board examination ____________________________________________________________ (f) Total Marks for the examination _________________________________________________ (g) Total number of marks secured in the _____________________________________________ examination including excess marks over the pass marks in the optional papers. (h) Division or class obtained in the examination _________________________________________________________________ (i) Percentage of marks obtained in aggregate. (Attested copy of Marksheets is to be attached.)_____________________________________ (j) Did a candidate pass the examination at (a) above in the FIRST ATTEMPT or in more than one attempt__________________________________________________________________ (k) Did a candidate appear and pass the examination at (a) above as a REGULAR CANDIDATE OR PRIVATE CANDIDATE. _______________________________________________ ___ 6. Whether the candidate is in receipt of any other scholarship (yes or no) _______________________________________________________ If yes, Please give details: --- (a) Name of the Scholarship Scheme _________________________________________________ (b) Course of study for which the Scholarship is awarded __________________________________________________________________ (c) Year of award__________________ 7. Particulars of the Course undertaken :-- (a) Course of study undertaken _____________________________________________________ (b) Class in which studying this year _________________________________________________ (c) Subject of the Course of study taken at (a) above ____________________________________ 8. Certify that the statement made by me in this form is correct. I declared that in case I am selected for the scholarship, I shall devote my full time to the Course of study, and that I shall not receive any other scholarship from any other source. Place ___________________________ Date ____________________________ ______________________ Signature of the Candidate Enlcosures:-- (1) __________________________ (2) __________________________ (3) & __________________________ ANNEXURE 'A' JOINING REPORT This is to certify that Shri/Smti/Kum _________________________________________________ Son/Daughter of Shri _____________________________________________________ has been granted admission in this Institution for the ___________________________________ Course and has joined the ____________________________ Class with effect from ______________________________________ (i) The duration of the Course which the student is studying in this Institution is ______________ years and the date of commencement of the academic session is from ____________________ (ii) The subject of the Course of study at (i) above taken by the student _____________________ (iii) The course of study in Degree Diploma/Certificate/Trade course/Professional Course Cross out which is not applicable) (iv) The name of the nearest branch of State Bank of India or Government Treasury through which the payment of scholarship is desired _____________________________________________ (v) The Designation full address of the Institution where the Scholarship amount in respect of the student may be sent. I also certified that this Institution is affiliated to the ____________________________________ ________________________________ University/Board and is recognized by the Government of Indian State Government of ______________________________________________________________ No ____________________ Place __________________ _____________________________ Signature of the Head of the Institution Date ___________________ Name in Capital Letter ______________________________ _________________________________________________ Address __________________________________________ Seal _____________________________________________ FOR USE IN THE OFFICE OF THE DIRECTOR OF PUBLIC INSTRUCTION, MEGHALAYA, SHILLONG. I. Total amount sanctioned during 200__ 200__ Checked by Dealing Assistant Dy. Director of Higher and Technical Education, Meghalaya, Shillong. APPLICATION FORM FOR POST GRADUATE RESEARCH SCHOLARSHIP FOR 200_____ 1. Name of candidate Shri/Smti (in block letter) __________________________________________ 2. Bonafied native of which District ___________________________________________________ 3. Home Address in full _____________________________________________________________ 4. Present Address _________________________________________________________________ 5. If He/She is an employee, if so the particulars:- (a) Designation: _________________________________________________________________ (b) Employer:- __________________________________________________________________ (c) Whether He/She will be released _________________________________________________ 6. Particulars of Academicals Examination passed Name of Examination Class or Division P.C. of Marks secured Year of passing Name of Board or University Remarks (a) School examination (b) Pre-University Examination (c) Degree Examination (d) Master Degree Examination (e) Any other Examination -- 7. Subject for Research ______________________________________________________________ 8. The Name of the Guide ___________________________________________________________ 9. Date of joining the Research Course _________________________________________________ 10. Name of the University or Institution for Research ______________________________________ 11. Duration of the Research Course ____________________________________________________ Signature of the applicant Signature of the guide with his Designation & Recommendation. Countersignature of the Head of the Institution with Official Seal and date. (a) All particulars must be supported by attested copies of certificate or mark-sheets. (b) In case on the candidate now in employment a certificate from the employer to the effect that he/she will be released from his/her duties for availing the Scholarship for Research if selected. (c) A certificate from the Deputy Commissioner of the District concerned to the effect that the candidate is bonafide resident of Meghalaya. (d) A certificate from the Guide Countersigned by the head of the University or Institution as to the suitability and progress of the candidate in research work. (e) The selected candidate will have to execute a bond before awarded of the scholarship to the effect that the entire amount shall be refunded if he/she discontinues or cannot complete the Research Works/Study/ during the tenure of the Scholarship or violates any term or condition of the award. Father's Name _____________________________________________________________________ Home Address _____________________________________________________________________ Post Office ________________________________________________________________________ P.S ______________________________________________________________________________ Nationality ________________________________________________________________________ District ___________________________________________________________________________ Particulars of the University where research studies have been undertaken; Name of the University ______________________________________________________________ Department ________________________________________________________________________ Course ____________________________________________________________________________ Subject/Topic of the research studies ____________________________________________________ Name and Designation of the guide _____________________________________________________ Duration of the course _______________________________________________________________ Date of joining _____________________________________________________________________ (Certificate from the Guide with recommendation of the Head of the Department should be enclosed) FORM OF BOND Know all men by these present that I (student) _________________________________________ daughter/son of _______________________________ resident _______________________________________________________________ Village __________________________P.O _________________________ District _________________________________ and present address Vill/Town __________________________________________________ District ____________________ Do hereby agree for myself, my heirs, executor and administrator to carry out and perform following terms and condition that is to say 1. The said (student) ________________________________________________________________________________ hereby of his own free will and consent testifies by the execution by him of these presents, agrees with and to the Government of Meghalaya and his successors in office and assign that he, the said (student) _________________________________________________________ shall well and faithfully undertake his study in (subject or subjects) ____________________________________________________________________________________________ ________________________________ at the _________________________ where he has been awarded a scholarship by the Government of Meghalaya. 2. The said (student) ________________________________________________________________while prosecuting his studies in the said Institution ___________________________________________________________________ abide by the rules or orders laid down or given by the authorities of the institution for the conduct of its students and shall complete the course of the satisfaction of the authorities of the institution and to that of the Government of Meghalaya. 3. The said (student) ________________________________________________________________ shall after completing the course for which scholarship will be awarded and if so required by the State Government of Meghalaya to serve the Government of Meghalaya within the state for a period of not less than 3(three) years and during the whole of such period diligently and efficiently do all acts and discharge his duties which may be required to be done by him as an employee. 4. The Government of Meghalaya shall pay the said (student) and Scholarship @ Rs. ____________ Rupees. _______________________________________________) only for a period of 3 years or for completion of the course which ever is earlier. 5. The said (student) ___________________________________________________________ shall have to refund the Government of Meghalaya his successors in office and assign the total amount of the Scholarship paid by Government of Meghalaya in the vent of negligence failure to complete the studies idleness, insubordination or misconduct, refusal to take up service under the Government of Meghalaya or under the Aided Schools authorities concerned if any when offered by the Government of Meghalaya of Leaving it before the expiry of 3(three) years or while in service Breach of the condition here in above convenated or the part of the said (student). Signature of the student __________________________ Signed and delivered by the said student in the presence of: (Name in full) i. _____________________________________________________ and ii. _______________________________________________on the _______________________ Signature in full of the two officers with the undersignation: (1) ______________________________ on the ___________________________________________ Address ______________________________ day of __________________________________________ (2) _______________________________on the __________________________________________ Address ______________________________ day of __________________________________________
