State to which the Applicant belongs_............................ Application No...... FRESH APPLICATION FORM APPLICATION FOR MEGHALAYA POST·MATRIC SCHOLARSHIP TO OTHER BACKWARD CLASSES/ LOWER INCOME GROUP STUDENTS FOR PURSUING POST·MATRIC STUDIES For 20____ - 20____ LATE, INCOMPLETE OR DEFECTIVE APPLICATION WILL BE IMMEDIATELY REJECTED SUMMARY 1. Name of the candidate__________________________________________________________________ (In block capital letters Woman candidate should indicate whether Miss or Mrs.) 2. Name of the institution where the student is studying (200___- 200___) 3. Class In which reading during the current academic session 200____ - 200_ ___________ Roll No_______ Shift-Day/Night__________________ 4. Course of study undertaken______________________ Date of Joining the Class___________________ 5. (a) Whether belongs to OBC/LIG______________________________________________________ (b) Community______________________ Sub-Caste____________________________________________ 6. Results of the last University, Board/Annual Examination :- (a) Name of the Examination taken________________________________________________________ (b) Name of the Institution from which appeared and passed____________________________________ (c) Year of Passing____________________________ Division or Class obtained____________________ (d) Total marks obtained___________________________ Percentage of marks obtained______________ 7. Date of birth (10 Christian era) according to Matric or equivalent Certificate____________________________________________________________________ 8. Name of the (a) Father ____________________________________________________________________________ (b) Mother ____________________________________________________________________________ *(c) Guardian __________________________________________________________________________ *(In case where both mother & father have died) 9. Total annual Income from all sources ending_________________________________31st march 20____ (a) Father ____________________________________________________________________________ (b) Mother ____________________________________________________________________________ *(c) Guardian __________________________________________________________________________ *(In case where both mother & father have died) FRESH APPLICATION FORM FOR GOVERNMENTOF MEGHALAYA POST-MATRIC SCHOLARSHIP Note: This application should be submitted to the Director of Higher & Technical Education Meghalaya Shillong and must reach not later than 30th September 200_ Through the (Head of Institution)................ ............................... Applicant must affix a passport- size photograph wIth his her signature thereon PART - A (TO BE FILLED IN BY THE APPLICANT IN NEAT AND CLEAR HANDWRITING) 1. Name of the applicant in full ................................. (In block capital letters. Woman candidate should indicate Miss or Mrs) 2. Date of Birth (In Christian era and to be supported by attested copy of matric or equivalent examination certificate).............................. 3. Caste/Tribe and Sub-Caste/Sub-Tribe............................ 4. Present Address (in full) Community............. Religion.......... Village ................. PO............ District.............. State.............. 5. Permanent Address Village .............. PO.............. (state where permanently settled) in full District.............. State.............. Municipality........... Ward no ............. 6. Father's/Husband's name in full (In case of married woman student husband's particulars are Name & Address........................ invariably required). Detailed particulars of occupation should Occupation......................... be furnished whether employed in Government or private service....... 7. Mother's/Husband's name in full Designation ........................ (Detailed particulars of occupation should be furnished) Name & Address........................ Occupation.......................... 8. Applicant's occupation, If any Designation ....................... with name of office/location, post held, scale of pay, etc, are to be furnished........................................... 9. For the candidates pursuing Postgraduate studies including other part-time courses (like LL B, B.T. etc.) - i. Whether the candidate is pursuing more than one course of studies.. ...Yes or No. ii. If yes please indicate your option for scholarship in (b) below- a. The names of courses of studies undertaken.-1 ............... , 2 ............. b. Which of the above courses the. Scholarship is now desired.......................... 10. VVhether the candidate applied previously or separately applied for or already in receipt of scholarship under this scheme during 200___- 200_____ (please furnish particulars) a. Activities during the gap period............................. b. Whether the student studied in any institution after passing the last annual/final examination, and If so, name of the Institution and the year of study................... c. If answer to (b) is in the affirmative State when and with what result study was prosecuted ........................ d. If study was discontinued state reasons of discontinuance................................ e. State If you have changed course of study or institution without completion of the courses of study i.e. before appearing In the Final Examination..................................... f. If answer to (e) is in the affirmative state reasons........................................ g. Were you awarded scholarship for the course of study which you could not complete with particulars of year................... 11. . i. Class in which the applicant was studying during the preceding year.............. ii. If the applicant passed the last University/Board/Annual examination earlier than preceding year 20___-20_____ particulars of how he/she Occupied himself/herself after passing that examination should be given here *(a) to (g) is to be given in details 12. Particulars of examinations taken commencing with the Matriculation or equivalent Examination please attach attested copies 6f certificate and mark sheet Attested copy of Matric or equivalent examination certificate should invariably be attached without which the application will be rejected. Examination taken Dates in which examinat ion taken Year 'in which examination passed whether university, board or class examination Percentage or marks secured in the examination Class or division obtained in the examinat ion Name of the institution from which passed 1 2 3 4 5 6 7 1. Matriculation 2. HSL certificate 3. Higher secondary 4. Pre-university 5. I.A/I.Sc/I Com 6. BA/Bsc/B com part I 7. BA/Bsc/B com 8. Indian School certificate examination 9. Pre medical /agri/vety/engg 10. 1st MBBS /agri/vety/engg 11. MBBS 12. 1st yr Engineering etc 13. MA, MSc, Mcom prev 14. MA, MSc, Mcom etc 15. BT, LLB, etc 16. Any other matric course with name ii. Name of the institutions attended for last two years (a) .................. (b)................... 13. Number of children of the same parents/guardian who have already received/receiving and applying ....................... scholarship under this scheme All the names including applicant should be mentioned clearly ...................... In the Performa bellow :- (Declaration to be signed in form B) Sl No name Age Year class and course of studies for which scholarship awarded receiving and applying scholarship under this scheme Name of the Institution a. Name of children enjoyed scholarship In previous years1 2 3 b. Name of children enjoying/applying for scholarship this year 1 2 3 14. Particulars of the last annual examination taken by the student ii. Year In which examination taken with date iii. Name of the Institution last attended iv. Name of the examination v. Whether University/Board or Class examination vi. Whether candidate passed or failed vii. Whether regular pass or Compartmental or Supplementary or provisionally promoted viii. Date of passing or failing ix. Did he/she pass In one sitting x. Whether or not promoted to the next higher class xi. If candidate did not pass whether placed In Compartmental or Supplementary xii. If placed In Compartmental or Supplementary a. Whether debarred from attending lectures In higher classes b. Whether promoted to next higher class or not c. Date of promotion to the next higher class xiii. Roll No of candidate at University/Board examination xiv. University Registration No and year of Registration 15. Whether the candidate was in receipt of scholarship under this scheme or any other scheme In the preceding years ..................................Yes/No .... If yes please Indicate i. Name of the scholarship scheme ............................ ii. Course of study for which the scholarship was awarded .................. iii. Year and class the scholarship enjoyed last........................, iv. Name of the Institution m which the scholarship was awarded............................... . v. Sanctioning No and date................................ Allotted No..................value of scholarship............ 16. i. Course of study for which the scholarship is now desired ............................ ii. Whether full time or part-lime course............................ iii. Whether Day Time or Evening Time or Morning Time................ iv. Class In which studying this year......................... v. Subjects taken at (IV) above............................ ....................................... vi. Name of the Degree/Diploma/Certificate to which entitled after successful completion of the course of study................................ vii. Authority who Will award the Degree/Diploma/Certificate............... ......................................... 17. Whether residing In the hostel of the Institution or In an approved hostel ............Yes/No i. If yes, give Its name................................... ii. Address......................................... iii. Exact date of Joining................................... N. B.-Certificate from the Hostel Superintendent is to be attached 18. Documents to be attached i. Part 0 of the application form duly completed and signed by the Head of Institution ii. Caste Income and Citizenship Certificates (Annexure I) iii. Income Declaration (Annexure II) I/We hereby declare that l/We have read the regulation of the scheme and agree to abide by the terms and conditions of the award I/We certify that the statements made In the application are correct and If any of them is found to be false and incorrect by the authority whose decision will be final and bending on me/us, l/We undertake to refund to the said authority on demand !he entire amount of scholarship received by me/us or overpaid to me/us falling which the said authority may recover the amount from me/us through whatever means deems proper (1) Signature of the Applicant.................... (II) (a) signature/left Right hand thumb Impression of the parents/guardian................. (b) Full name in capital letters................... (c) Relationship to student.............. Place Date CASTE INCOME AND CITIZENSHIP CERTIFICATE ANNEXURE I i. Note -- (this certificate should be signed by either of the following) - [LOCAL-Member of Parliament/Member of State legislature /Deputy Commissioner /Sub - Divisional Officer (Civil)/Sub-Deputy Collector of the area (where the parents/guardian is permanently residing)] ii. In case of parent s/guardian who are employed persons, Income Certificate should be furnished from the head of the office/employers iii. This is a very Important/document as the scholarship is awarded mainly on the basis of this certificate The Issuing authority is therefore advised to Issue the certificate with due caution iv. In case of over-writing the Issuing authority should Initial the same (A) CASTE AND CITIZENSHIP CERTIFICATE I certify that to the best of my knowledge- 1. Shri/Kumari/Shrimati (name of the student).................Son/Daughter/ Wife of Shri (name of father/husband) ...........................a permanent resident of....................village/town................ P S...................District....................... Mauza/Ward No..............State..................Is a Citizen of India Shri/Kumari/Shrimati........................................ (Name of the student belong to the Backward /Backward Classes/General Caste and his/her sub-caste is...................his/her religion is ................... *Signature of the Issuing Place .................... Authority............... Date........................ Full name in capital........... letters Designation............... Address to full................ .......................... .......................... SEAL *Stamped signature will not be accepted **Certificate not being the seal of the Issuing authority if that be a gazetted officer will not be accepted Others may also affix their seal Available (B) INCOME CERTIFICATE This certificate IS to be signed by the persons as indicated al Note (II above and by the EMPLOYER IN CASE OF EMPLOYED Parents/GUARDIAN Certified that to the best of my knowledge the annual Income from all sources In the preceding year ending 31st March 200_ of Father/Mother/Guardian/Husband of the student Shri/Shrimati....... ..............................................................................are as follows (name of the student) i. Total Income of father Shri ..................... ..Rs. .................. (Rupees.......................................) ii. Total Income of mother Shri ..................... ..Rs. .................. (Rupees........................................) iii. Income of the student if any ..............Rs. ............... (Rupees.......................................) iv. Total income of guardians ............................... (only In the case where both the parents have died) Shri/Shrimati..................... Rs. .................. (Rupees.......................................) GRAND TOTAL of Income Rs. ............... (Rupees.......................................) *Signature of the Issuing Place .................... Authority............... Date........................ Full name in capital........... letters Designation............... Address to full................ .......................... .......................... SEAL *Stamped signature will not be accepted N.B -Separate Income certificate may be attached where father/mother are required to furnish Income certificate separately *Certificate not bearing the seal of the issuing authority. If that be a gazetted officer, will not be accepted Others may affix their seal available FORM OF DECLARATION OFINCOME ANNEXURE II FORM A (TO BE GIVEN BY PARENTS/GUARDIAN WHEN THE STUDENT IS NOT EMPLOYED WHEN PARENT ARE ALIVE PARENTS DECLARATION IS REOUIRED FOR MARRIED FEMALE CANDIDATE HUSBANDS DECLARATION IS REQUIRED) Whether my son/daughter/Shri./Shrimati......................student of ......................College has applied for grant of a scholarship . I Shri .. . .. ... ...son of Shri ................. (Address) Village........ ......... PO ....... district......... State......... declare.......... that my total annual Income from all sources In the preceding year ending 31st March 200 was............(Rupees...........................)as per details furnished below I also affirm that particulars of property held by me are as (per details furnished In the Schedule here under and that I have correctly Indicated the amount of various taxes cesses and land revenues paid by me I make myself personally responsible for the accuracy of the facts and figures furnished I further undertake that In the event of the particulars given In this declaration being found to be false I shall refund to the President of India the whole amount of the scholarship paid to the said ........... .........................and the Government s decision on whether the declaration or particulars is false shall be final and binding on me Place .................... Signature .............. Date........................ FORM B Declaration to be given by parents guardian regarding the number of children receiving Post-Matric scholarships (According t0 the regulation not more than two children in the same family will be eligible to receive Post-Matric scholarship and this restriction is not for two children at any particular time but two Children of the same family for all times to come ) I Shri/Shrimati...................son of Shri/Shrimati................ Address................. PO .............District ............. declare that not more than two of my children have received or Will receive Post-Matric scholarship Place .................... Signature .............. Date........................ SCHEDULE (PARTICULARS TO BE FURNISHED BY ALL CANDIDATES, IRRESPECTIVE OF ANY CASTE AND COMMUNITY, WITHOUT WHICH THE APPLICATICN 1S LIABLE TO BE CANCELLED) 1. EXTENT OF LAND HELD - i. Area ii. Village iii. Survey No iv. Land revenue assessment 2. PROPERTY HELD (Houses Shop building House Sites) i. House No ii. Sheet iii. Village /Town/ City iv. Area of site v. Rented derived, If any vi. House tax paid vii. Address of shop viii. Nature of trade ix. Sale-tax income-tax paid x. License No 3. SALARIES DRAWN - i. Name of the employer ii. Office/unit in which he/she IS working iii. Full address iv. Monthly emoluments (including pay allowances etc v. Other benefits like house-rent allowance free house and other pre-requisites 4. OTHER SOURCES OF INCOME - i. Income from business industries etc ii. Amounts drawn as wages part time occupation iii. Any other source of Income (Signature or left/right thumb Impression of parents' Guardian/husband/self as the case may be) Place .................... Name................. Date........................ Address................ PART B TO BE FILLED IN BY THE HEAD OF THE INSTITUTION WHERE THE APPLICANT IS STUDYING THIS APPLICATION IS TO BE FORWARDED AFTER THOROUGH SCRUTINY FOR ELIGIBILITY i. The statements made by the applicants In Part IA are correct to the best of my knowledge and the caste certificate has been checked ii. Character. conduct and attendance of the applicant (general review ) iii. Whether you recommend the applicant for the award of a scholarship iv. Duration of the course which the applicant is studying In your institution (a)..............years (b) ...........months v. Whether Degree/Diploma Certificate Trade/Professional Course.................................. vi. Authority Issuing the above Degree etc............................ vii. Date of commencement of the current academic session of this course............................... viii. last date of admission fixed by the University/Board etc.................................... ix. Exact date on which the applicant Joined that course/class this year................................ x. likely date month and year on which the annual examination to the current session will be over (including Practical Subjects) .......................................... xi. (a) Is the applicant exempt from payment...................Yes/No of tuition fees xii. (b) If yes please Indicate whether exemption is for full or half tuition fees............................................ xiii. If the applicant IS residing In an approved hostel please indicate if he/she is entitled to free board and lodging/free board/free lodging ......................................... xiv. Exact date of admission to the said approved hostel ..................................... xv. The name of the nearest branch of State Bank of India or the Government Treasury through which the payment of scholarship is desired should be stated here.............................. xvi. The designation and full address of the Head of the Institution to whom the scholarship amount in respect of this student may be sent................................... xvii.The student is required to pay the following fees during 200 - 20 which are not reimbursed by State Government or from any other source Course Amount payable for the year Day Section Course Amount for the year night section a. b. c. d. e. f. g. h. i. Admission fee Enrolment or Registration fee (i) Tuition fee ii. Science or laboratory fee (if any) (non-refundable portion) Games fee Union fee Library fee Magazine fee Medical examination fee charged by the Institution Examination fee a. charged by the Institution b. charged either by the University or by any other body which conducts the examination Total fees payable during 200 -200 Certified that this institution is affiliated to the ............................ University/Board and is recognized by the Government of India/State Government of.......... The applicant is studying.................... course In this Institution and the minimum qualification required for admission to that course is a pass In the............ .................... Examination. I undertake that the scholarship amount in respect of the applicant If and when placed at my disposal will be disbursed by me for the Specific purposes for which It is given and the accounts will be regularly rendered to the authority which awarded the scholarship In case the applicant leaves the Institution or otherwise discontinues the studies or accept any other regular scholarship/stipend the fact will be Immediately reported to the said authority and payment of scholarship to the applicant will also be discontinued The undisbursed amount lying with the Institution on account of maintenance charges fees etc will also be refunded In the Government account *Signature of the head of the Institution No .................... Name in capital letters................ Place .................... Date........................ Designation .................... Address to full................ .......................... .......................... SEAL of the institution *Stamped signature will not be accepted For use of the office of 1. Total amount of fees at (a! (XVi) above)......... .......... the D P I Meghalaya 2. Maintenance with effect from........ to........... @ Rs............. pm Amount passed for payment Rs....... (in words) Rupees........ ..................................................... Checked by D PI, Meghalaya [ThIs section is to be used by the office of D H T E Meghalaya Shillong In case the application is found Incomplete] Reason for objection - Note The following documents/particulars are required to be furnished - i. Attested copy of Certificates/ mark sheets of all Board university examination passed to be attached In Support of column 12 (Page 3) ii. Caste Income and Citizenship Certificates should be furnished by the competent authority as per Annexure-1 (Page 6) (b) In case of erasing or overwriting the same should be authenticated by the Issuing Person concerned. otherwise the same will be rejected iii. In case of parents who are employed In Government Semi-Government autonomous or private agencies etc the certificate from the employer should be furnished vide Annexure--1 (B) (Page 6) iv. So long as either of the parents (or husbands In the case of married unemployed girl students) are alive, only the income at the parents/or husband (as the case may be) from all sources has to be furnished Only In cases where both the parents (or husband In the case of married but unemployed girl student) have died. the Income of the guardian who IS supporting the student in his/her studies has to be taken v. No column of the application should be left unanswered vi. To enclose a Passport-Size Photograph
