north south foundation. g. ashwathanarayana no. 290/33, "maruthi krupa",11th cross 4th...
TRANSCRIPT
NORTH SOUTH FOUNDATION
(Application for College Scholarship - Fresh)
Dear Applicant,
Welcome to NSF India Scholarship program. This program is meant for economically backward
students in India who have obtained merit-based admission to professional courses like Engineering,
Medicine, Agriculture, Nursing, Polytechnic etc in Govt or Govt-aided colleges or under Govt. quota
seats in private colleges. All the following criteria need to be met to be considered for this scholarship.
Economic Criteria: Students with annual family income of Rs. 65,000 or less are eligible to apply for
this scholarship. However, we may make exceptions to this based on other aspects like adverse family
circumstances and personal hardships. Opportunity to avail scholarships from other agencies will be
considered, before making a final decision to award scholarships to students.
Academic Criteria: Students who have scored within the top 10% rank in their state are eligible to
apply for this scholarship. Additional allowance of 5% each will be considered for students with
disadvantages like being from a rural area or a girl student or physically challenged. We give priority to
the first member of the family to go to college and those with other compelling circumstances.
Integrity: We expect highest level of integrity from applicants when filling out this application form.
Any indication of wrong doing will result in the rejection of the application and disqualification from
applying again.
Certificate copies: Attested copies of the relevant documents listed at the end of this form need to be
mailed along with your application form to the NSF chapter office in your state or to the NSF
Hyderabad office. Details of NSF India Chapter Coordinators are are given at the end of this form.
Limitations: Scholarship grants are limited to the availability of funds and other resources at NSF.
Final: All decisions made by the NSF India Scholarship Team are done in good faith and are final.
Wish you all the best.
NSF India Scholarship Team.
2012
NORTH SOUTH FOUNDATION
(Application for College Scholarship - Fresh)
Registration No:
ADDRESS PERMANENT ADDRESS RESIDENTIAL ADDRESS
Address Line 1
Address Line 2
Village / Town / City
District
State,Pincode
PAST EDUCATION DETAILS (* G-Government, GA- Government Aided, P- Private)
Class Name of the School Year of
Passing
Category*
(G/GA/P)
Percentage
(%)
Tuition
Fees (Rs)
JNV
(Tick One)
IX Yes / No
X Yes / No
XI Yes / No
XII Yes / No
Diploma
/ ITI Duration
Addl
Info
XI, XII info or Diploma / ITI info is required. Tick Yes or No for whether studied at JNV School.
[ - Mandatory (Have To Be Filled)]
NSF- Application For College Scholarship -2012 Page 1/4 This application form is FREE for students. Charging a price for this form is illegal
Gender(M/F) Place of Birth Date of Birth
Reservation Class BPL Card Number
Mobile Number Landline Number
Family Annual Income Frequency of Email Use
Physically Challenged(Y/N) First Graduate In Your Family(Y/N)
Where did you hear
about NSF
Additional Details
Chapter / State
First Name(or Given Name)
Last Name(or Surname or Family Name)
CURRENT EDUCTION DETAILS
Name of the Degree Applied Branch/Department
Name of the Entrance Test
Marks Core (%) Overall (%) State Rank
Name of the College
College Postal Address
College Phone No Email
College Web Address
Course Duration Year of Joining Year of Completion
Where do you reside? Other option if Scholarship
is not awarded
Expenses per year (Rs) Tution Fees Boarding
Books Others Total
FAMILY DETAILS
Relation Name Age Occupation Education Annual
Income
Father
Mother
Brother(s)/
Sister(s)
FINANCIAL SUPPORT DETAILS - ( Rs per Year)
Merit Scholarship Amount from the Loans
Amount from the Family Amount from the
Relatives or Other Sources
On Poverty/Community
Basis (Govt Support)
Total from all Sources
NSF- Application For College Scholarship – 2012 Page 2/4
This application form is FREE for students. Charging a price for this form is illegal
Describe your family's circumstance in detail that makes you apply for this scholarship:
State what you would do after completing the course for yourself, your family and the society in
general:
Self:
Family:
Society:
DECLARATION BY THE APPLICANT I hereby declare that all the information given above is true to the best of my knowledge. In case, any
discrepancy is noted, NSF has all rights to terminate my scholarship and collect all funds paid to me with
interest. I declare that my character and behavior will be exemplary and shall maintain high academic
standards and values, thereby setting an example to others. I will inform NSF about all changes in my address
and contact information during the course and after. After getting a job, I will help other poor students.
Place: Student’s Signature:
Date: Student’s Name: (In capital)
DECLARATION BY THE PARENT/GUARDIAN I hereby declare that all the information furnished above by my ward is true and there is no factual error. I take full responsibility for the accuracy of the information furnished in the application. In case of any discrepancy, I agree to refund the money received as scholarship along with the interest to the NSF. Place: Parent’s Signature:
Date: Parent’s Name: (In Capital)
NSF- Application For College Scholarship - 2012 Page 3/4 This application form is FREE for students. Charging a price for this form is illegal
Important points to note when filling application and submission of documents:
All applicants should take due care to fill in details as per the space provided in the application form.
All required columns must be filled and try not to leave any column blank. All columns must be filled in with
candidate’s own handwriting.
The following supporting document should be submitted along with the application. Please do not send any originals. Put a Tick-mark if the corresponding documents attached.
College Admission Card (attested)
Rank Card from the entrance examination (attested)
Certificates showing marks secured from class 10th to 12th
attested by the Head of the Institution.
Proof of the tuition fee paid/payable per annum duly certified by the college authorities.
Receipts or proof of tuition fee paid in X Class and XII Class (Plus 2 or Intermediate)
Income Certificate from District Revenue Officer
Ration Card indicating if the family is receiving rice, sugar, fuel, etc. from govt. at nominal prices
Two Passport size Photographs of applicant with name written on the back of it.
A Certificate from the College in the following format:
To whom it may concern
This is to certify that ________________________________, S/D/o_____________________, at/Post:
__________________________________ is a bona fide Student of this College.
He / She is studying in__________Class/Year of this College. He / She is not eligible for or in receipt of
any Scholarships or other financial help from anywhere through this Institution since his admission to
this College.
Signature:
Principal/Head:
College Seal:
NOTE ‐ Attestation of 1, 2 and 3 can be by any Gazetted Officer or College Principal/Head Master.
College Admission Card (attested)
NSF- Application For College Scholarship - 2012 Page 4/4 This application form is FREE for students. Charging a price for this form is illegal
Please send completed applications to the NSF India Chapter Coordinator in your state. If your state does not
have an NSF Chapter, please send it to NSF Chapter in Hyderabad, AP. See enclosed list of addresses.
If you have any questions send an email to [email protected]
NSF India Chapter Addresses. Please Keep For Your Information.
Hyderabad, Andhra Pradesh
D. Seetaramaiah
Room No. 316, Model House
3rd Floor , Panjagutta
Hyderabad , Andhra Pradesh‐500082
Phone (Mobile): 9000006198
Tanuku, Andhra Pradesh
N. Ganesh
Chowdary Spinners Limited
1-168,Chivatam
Tanuku,Andhra Pradesh-534216
Phone (Mobile): 9959056002
Vizag, Andhra Pradesh
Arun Kumar Pappala
D.No. 45-35-8/2
Bhaskar Villa Apartments
Akkayyapalem
Vizag,Andhra Pradesh-530016
Phone (Home): 0891-2505789
Guwahati, Assam
Apply to Hyderabad address above;
Patna, Bihar
Sushil K. Sinha
Flat # 203, Chandi House
Exhibition Road
Patna-800001
Chandigarh, Chandigarh
Meera Sharma
#9 Police Complex, Sector 17 E
Chandigarh-160017
Phone (Mobile): 987619 2935
Bhavnagar, Gujarat
Bipinbhai Shah
Vikas Vartul Trust
Post Box No.1, Gangajalia Talav
Bhavnagar,Gujarat -364001
Phone (Home): 0278-2430103
Panchkula, Haryana
Sudha Babbar
Jainednra Public School
Zirakpur-Kalka Road, Sector 1
Panchkula, Haryana -134108
Phone (Home): 0172-2567541/2584571
Bangalore, Karnataka
Dr. G. Ashwathanarayana
No. 290/33, "Maruthi Krupa",11th Cross
4th Main,Mahalakshmi Layout
Bangalore,Karnataka -560086
Phone(Mobile): 8951813386 (11 am to 5 pm,
MON to FRI only) [email protected]
Mysore, Karnataka
Nataraj K.R
Center Head, KEONICS yuva.com
K.R.Nagar
Mysore,Karnataka-571602
Phone(Mobile):9448150745
Kochi, Kerala
T U K Menon
Chips Software Systems
Sahitya Parishad Building (1st floor)
Hospital Road
Kochi,Kerala -682018
Phone (Home): 0484-6465218
Aurangabad, Maharashtra
Dr.Satish M.Roplekar
Tilaknagar, Ulkanagari
Aurangabad,Maharashtra -431005
Phone (Home): 02402-335002 /321941 Phone(Mobile):9822041959
Pune, Maharashtra
Maj Gen (Retd) S C N Jatar
Office #12
Prime Centre Bahirat Patil Chowk
( N Om Super Mkt)
Model Colony
Pune,Maharashtra -411016
Bhubaneswar, Orissa
S.C. Choudhury
Chairman Vikash Educational
Charitable Trust
1st Floor, 'ROSE DALE',
139, District Centre, Chandrasekharpur
Bhubaneswar,Orissa -342001
Phone (Home): 0674-2740100
Phone (Mobile): 9338101876
Patiala, Punjab
C.R. Sofat
# 4231 Phase 2
Urban Estates
Patiala, Punjab-147002
Udaipur, Rajasthan
Raja Harsh Raj Pandya
House No.16-17
Surya Estate
Hiran Magri, Sec.11
Udaipur, Rajasthan -313002
Phone (Mobile): 9887888786
Jodhpur, Rajasthan
Damodar Das Moondra
201, Shiv Sunder , 42A PWD Colony
Jodhpur, Rajasthan -342001
Phone (Home): 0291-2617803
Phone (Mobile): 9414195803
Chennai, Tamil Nadu
Mrs.N.Annapoorani
A3/9, Tristar Apt
Mogapiear West
Chennai, Tamil Nadu -600037
Phone (Home): 044-26532747
Madurai, Tamil Nadu
S Ramanathan Iyer
17, North St , Kalai Nagar
Madurai, Tamil Nadu -625014
Phone (Home): 0452-640678
Phone (Mobile): 9442564078
Nagercoil, Tamil Nadu
Ernest Vijay
RedEgg Infoexpert Technologies Pvt Ltd
Door No: 379A
Near the Tourist Bungalow ,K.P. Road
Nagercoil, Tamil Nadu –629001
Phone (Home): 04652-403971
Moradabad, Uttar Pradesh
Vivek Maheshwari
Anglo-Vedic Convent School
Bahjoi
Moradabad , Uttar Pradesh
Phone (Mobile): 9927048713
Noida, Uttar Pradesh
Jyotsna Srivastava
Setu , C7/7 Sector 31
Nithari Village
Noida,Uttar Pradesh -201301
Phone (Mobile): 9958914533
Kolkatta, West Bengal
Pankaj Karmakar
Director M/S Icon Engineers P Ltd
3/B Gobinda Ghosal Lane
Kolkata, West Bengal -700025
Phone(Home): 033-24548112/24548852
If your state is not listed, please send to Hyderabad chapter. Questions? Email: [email protected]