ANNEXURE-A APPLICATION FORM FOR BOOK GRANT TO STUDENT PROSECUTION POST MATRIC STUDIES IN COURSES OTHER THAN TECHNICAL COURSES (To be submitted to the Director of Higher & Technical Education, Meghalaya through the Head of the Institution concerned) Year ...... 1. Name of the applicant in full __________________________________________________________________ (in block letter) 2. Father's Name or Mother's Name or Guardian's __________________________________________________ (a) Present address _________________________________________________________________________ (b) Permanent address ______________________________________________________________________ (c) Occupation ____________________________________________________________________________ (d) Parent's of Guardian Annual Income ________________________________________________________ 3. Date of birth of the applicant (Student)__________________________________________________________ 4. Whether the applicant is a Tribal Student and a permanent resident of the State of Meghalaya (certificate to be enclosed) ___________________________________________________________________ 5. Whether the applicant belong to a Khasi/Jaintia/Garo ______________________________________________ Community (certificate to be enclosed) 6. Particulars of examination/passed commencing from H.S.L.C, or equivalent (Mark sheets to be attached) 7. Name of the Institution where the Student is Pursuing studies ________________________________________ 8. Course of studies and academic year ___________________________________________________________ 9. Whether reading in Day or Evening shift ________________________________________________________ 10. Whether the applicant is employed under any Government _______________________________________ service. If so in what capacity and in what Office. 11. Whether the applicant was in receipt of any book grant __________________________________________ earlier for the same course of studies if so, the year and the amount receiving any Scholarship. Name of Examination Board/University Year of passing Maximum Marks Marks Obtain Percentage of marks secured Division of Class I here by declare that the statements/particulars given above are correct. I undertake to refund the grant if any of the particulars given is found to be false or incorrect. Signature of the Applicant (student) Signature of Parent/Guardian CERTIFICATE FROM THE HEAD OF THE INSTITUTION Memo No. ___________________________________________________________________________________ The application is recommended/not recommended. Certified that Shri/Shrimati ________________________________________________________________ Where particulars are given above has been admitted into the ___________________________________________ Year/Class ____________________________________ course in Day/Night/Morning Shift in this College which is affiliated to the __________________________________________________________________ University or recognized by ____________________________________________________ Signature of the Head of the Institution and Seal FOR USE IN THE OFFICE OF THE DIRECTOR OF HIGHER & TECHNICAL EDUCATION MEGHALAYA : SHILLONG 1. Sanctioned amount of Book Grant Rs. ______________________________________________________ (Rupees ______________________________________________________________________________) Check by Deputy Director of Higher & Technical Education Dealing Assistant Meghalaya : Shillong. 78
