the following documents (xerox copy) should be …

SC, ST & SCC (BC-Adi Dravidar Christian) Scholarship - Fresh Application Form

IMPORTANT NOTE:

THE FOLLOWING DOCUMENTS (XEROX COPY) SHOULD BE ENCLOSED ALONG WITH

THE SCHOLARSHIP APPLICATION FORM OTHERWISE THE APPLICATION WILL BE

LIABLE TO BE REJECTED.

1). Attested Photocopy of Community Certificate.

2). Attested Photocopy of Income Certificate (2018). (Income certificate period should not exceed 6 months at the time of admission)

UG Students:

(Income limit for SC/ST Candidates – Below Rs. 2,50,000/-)

(Income limit for SCC (BC - Adi Dravidar Christian) Candidates – Below Rs. 2,00,000/-)

(Income limit - above Rs. 2,50,000 to Rs. 9,99,999/- Eligible for Free Education

Scholarship)

PG Students:

(Income limit for SC/ST Candidates - Below Rs. 2,50,000/-)

(Income limit for SCC (BC - Adi Dravidar Christian) Candidates - Below Rs. 2,00,000/-)

(Income limit for PG Girls only - above Rs. 2,50,000 to Rs. 9,99,999/- Eligible for

Free Education Scholarship)

3). Attested Photocopy of Student Savings Bank Pass Book with full transactions.

(*Linking Bank A/c. No. to Aadhaar is mandatory)

4). Attested Photocopy of SSLC (10th) Mark Sheet(s).

5). Attested Photocopy of Hr. Sec. (12th) Mark Sheet(s).

6). Attested Photocopy of UG, PG Mark Sheets, Provisional/Degree Certificate. (for PG & M.Phil. Students only)

7). Attested Photocopy of Aadhaar Card. (*Linking Aadhaar No. to Bank A/c. is mandatory)

(The Students those who want to submit an application in the College office for claiming

scholarship are requested to take printout on both sides from 2nd page onwards in A4 size

paper (except 1st page).

[

APPLICATION SUBMISSION LAST DATE : Before 10th August 2018.

College Main Office – Counter No.3

*******

DEPARTMENT OF ADI DRAVIDAR & TRIBAL WELFARE

FRESH - Application form for ADW Scholarship Scheme (Tamil Nadu e-District) --------------------------------------------------------------------------------------------------------

INSTITUTION NAME : SACRED HEART COLLEGE (Autonomous), Tirupattur, Vellore Dt.

-------------------------------------------------------------------------------------------------------- for office use only (Student ID) -------------------------------------- ACADEMIC DETAILS :

Academic Year : 2018 - 2019 Shift - I (Aided) / Shift - II (Self-Supporting Course)

Course Name : Year : I / II / III

Studying Course Type : Self Support / Regular Lateral Entry : Yes / No

Date of Admission : .……./……../2018 Student Reg. No.:

-----------------------------------------------------------------------------------------------------------------------------

PERSONAL DETAILS :

Name of the Applicant : (Block Letters - as per 12th Mark sheet)

Father / Guardian Name : Mother Name :

Occupation : Date of Birth : ___ /___ /_______

Community : SC / ST / SCC (BC - Adi Dravidar Christian) Caste :

Gender : Male / Female Religion : Hindu / Christian

Annual Family Income : Rs. _______________ Admission Mode : Govt. / Payment (Income Certificate period should not exceed 6 months at the time of admission)

First Graduate : Yes / No 10th Reg. No. _____________ 12th Reg. No. _____________

------------------------------------------------------------------------------------------------------ Email ID: Mobile No. : ------------------------------------------------------------------------------------------------------ Address for Correspondence : Door No. :

Street / Nagar :

Village :

Post :

Taluk :

District :

Pin Code :

Aadhaar No.: (12 Digit No.) * Linking Aadhaar No. to Bank A/c. is mandatory

-------------------------------------------------------------------------------------------------------- BANK DETAILS :

Student Bank Account Number : (*Linking Bank A/c. No. to Aadhaar is mandatory) (Please enter the full digits of Account Number)

Name of the Bank : Branch Name :

IFSC Code: MICR:

(IFSC Code should be 11 Digit.) (MICR Code should be 9 Digit.)

HOSTEL DETAILS :

Hosteller : Yes / No If Yes : Paid Hostel / Free Hostel

Hostel Name :

Date of Joining : ….. / ……. / 2018 Date of Leaving : 31/05/2019

--------------------------------------------------------------------------------------------------------

Date : ___ / ___ / 2018 Signature of the Applicant

2 0 1 8 0 4 0 1 0 A D W 0 0

0

M.jp.g.e. 73---1>000---2016----m.fp.m.> GJif.

jkpo;ehL muR

GOVERNMENT OF TAMIL NADU

Mjpjpuhtplu; kw;Wk; goq;Fbapdu; eyj;Jiw

ADI-DRAVIDAR AND TRIBAL WELFARE DEPARTMENT

kj;jpa / khepy muR fy;tp cjtpj; njhif jpl;lk; - gs;sp ,Wjp Nju;Tf;F Nkw;gl;l gbg;gpw;Fupa cjtpj; njhif ngWtjw;fhd tpz;zg;gk;

FORM TO APPLY FOR THE GRANT OF GOVERNMENT OF INDIA / STATE GOVERNMENT

POST MATRIC SCHOLARSHIPS.

SACRED HEART COLLEGE (Autonomous),

TIRUPATTUR - 635 601, VELLORE DT.

REG. NO.:

CLASS : I -

YEAR : 2018 - 2019

1. khztu; ngau; : (njspthd vOj;Jf;fspy;) jpU / jpUkjp / nry;tp. Full Name of the Student (in Block letters)

Thiru / Thirumathi / Selvi.

2. jha; / je;ij / ghJfhtyu; ngah; : Name of the Mother / Father / Guardian.

3. njhopy; / Occupation. :

4. epue;ju Kftup / Permanent Address. :

5. m. khztu; gapYk; gbg;Gg; gpupT : Course of Study of the applicant.

1. Nky;epiy tFg;G / Higher Secondary Class.

2. gl;lg;gbg;G / Degree Course.

3. gl;l Nkw;gbg;G / Postgraduate Course.

4. njhopw;gbg;G / Professional Course.

5. gl;lag; gbg;G / Diploma Course.

6. rhd;wpjo; gbg;G / Certificate Course.

M.jp.g.e. 73---1

khztupd; Gifg;gl efy; ,izf;fg;gl

Ntz;Lk;

STUDENT ID :

201804010ADW00

2

5. M. gapYk; Kiw / Category of Study.

1. gfy; Neuk; / Day Time

2. khiy Neuk; / Evening Time

3. gFjp Neuk; / Part-Time

4. mQ;ry; top / Correspondence

,. gbg;G Kiw fhy msT / Duration of Course

3 Years, 2 Years, 1 Year

6. gapYk; epWtdj;jpd; ngaUk; mjd; KOikahd mQ;ry; Kftup. Name of the Institution where studying and its

complete Postal Address.

SACRED HEART COLLEGE (AUTONOMOUS)

TIRUPATTUR - 635 601, VELLORE DIST.

7. fy;tp epiyaj;jpy; Nru;e;j ehs; Date of Joining the Institution

ehs; Date

khjk; Month ;

Mz;L Year

2018

8. gj;jhk; tFg;G nghJj; Nju;tpy; Nju;r;rp ngw;w Mz;L / gjpT vz;. Year and Register No. of Passing of the10

th

Public Examination.

Mz;L Year

gjpT vz;. Registration No.

9. gl;bay; ,dj;jtu; / goq;Fbapdu; / fpwp];jt ,dj;jpw;F khwpa gl;bay; ,dj;jtu; (tl;lhl;rpau; toq;fpa epiyahd rhjpr; rhd;wpjopd; Gifg;gl efy; ,izf;fg;gl Ntz;Lk;). goq;Fbapdu; ,dj;ijr; Nru;e;jtu; vdpy; tUtha; Nfhl;lhl;rpau; rhd;wpjo; my;yJ 11-11-1989-f;F Kd;du; ngw;w tl;lhl;rpau; rhd;wpjopd; Gifg;gl efy; ,izf;fg;gl Ntz;Lk;. Cgrhjp ngau; Fwpg;gpLjy; $lhJ. Scheduled Caste / Scheduled Tribes / Scheduled

Caste Converted to Christianity. A xerox copy of the

Community Certificate issued by the Tahsildar in

respect of SC / SC Christian and certificate issued by

the R.D.O. or the certificate issued by the Tahsildar

before 11-11-1989 in respect of S.T. should be

attached Sub Caste should not be mentioned.

1.

2.

3.

gl;bay; ,dj;jth; Scheduled Caste fpwp];jt kjj;jpw;F khwpa gl;bay; ,dj;jtu; Scheduled Caste Converted to

Christianity.

goq;Fbapdu; Scheduled Tribe.

10. tpz;zg;gjhuupd; ngw;Nwhu; (jha; / je;ij) ghJfhtyu; / fztupd; gy;NtW tifapy; <l;ba nkhj;j Mz;L tUkhdk; (tpz;zg;g ehSf;F Ke;ija MW khjq;fSf;Fs; ngwg;gl;l tl;lhl;rpau; rhd;wpjo; ,izf;fg;gl Ntz;Lk;). Gross annual income of the parent / guardian /

husband from all sources to be furnished (income

certificate issued by the Tahsildar and obtained

within Six months period to date of application

should be attached).

Rs.

.

3

11. gj;jhk; tFg;Gf;Fg;; gpd;du; gapd;w gbg;Gfspd; tptuk; / ,ilepWj;jk; ,Ug;gpd; mjd; tptuk;. Details of Postmatric Courses after 10

th standard in

which applicant studied / Details of break of study

should be furnished.

gapd;w Mz;L gbg;G tptuk;

fy;tp epiyaj;jpd; ngau; Name of the Institution

fy;tp cjtpj; njhif ngwg;gl;ljh?

tUif tpOf;fhL nrd;w Mz;Lf;F

kl;Lk.; Details of study

undergone together

with year of study.

Whether obtained

Scholarship.

Mk; / ,y;iy Yes / No

Percentage of previous

year attendance.

(1). (2). (3). (4).

12. khzthpd; tq;fp fzf;F vz;. Student Bank Account Number. :

1. tq;fp ngah; / Bank Name :

2. tq;fp fpis / Bank Branch :

3. MICR FwpaPL / MICR Code :

4. IFSC FwpaPL / IFSC Code :

5. kpd;dD jPh;it gw;W chpikf; fl;lis gbtk; my;yJ tq;fp fzf;F Gj;jfj;jpd; Kjy; gf;f efy; ,izf;fg;gl;Ls;sjh? Whether ECS credit

mandate form enclosed? or enclosed Bank Pass Book

First Page Copy.

Mk; / ,y;iy

Yes / No

6. kpd;dD jPh;it / Njrpa kpd;dD epjp ghpkhw;wk; /

RTGS Kiwapy; fy;tp cjtpj; njhifis Nrkpg;Gf; fzf;fpy; Nrh;f;f khzthpd; Nrkpg;G fzf;F guhkhpf;fg;gLk; tq;fp Core Banking

solution trjp mspf;fg;gl;l tq;fpah? To Facilitate ECS / NEFT / RTGS Transactions

whether the Bank is CBS enabled?

Mk; / ,y;iy

Yes / No

7. khzthpd; njhiyNgrp / miyNgrp vz;. Student Phone / Cell Number.

,lk;: khztu; / khztpah; ifnahg;gk; Station: Tirupattur, Vellore Dt. Signature of Applicant

ehs;: Date: ___ / ___ / 2018.

M.jp.g.e. 73---2

4

cWjpnkhop DECLARATION

vdJ Foe;ijfspd; tptuq;fs; kw;Wk; mtu;fs; ngw;w fy;tp cjtpj; njhif tptuq;fs; Details of my Children and the details of Scholarships received by them for

Postmatric studies.

njhlu; vz;>

ngau; ,Wjpahfg; gbj;j kw;Wk; jw;nghOJ gbf;Fk; fy;Y}upapd;

ngau;.

ngwg;gl;l my;yJ tpz;zg;gpj;Js;s njhiff;Fupa

Mz;L.

ngwg;gl;l gbg;Gjtpj; njhif.

Serial

Number

Name

Name of the

Educational Institution

last studied and now

studying

Year of which

scholarship

received or

applied for

Amount of

Scholarship

received

1. 2. 3. 4. 5.

Fwpg;G:- ngw;w midj;Jf; fy;tp cjtpj; njhiffisg; gw;wpAk; Fwpg;gpl Ntz;Lk;. Details of all Scholarship received by your children should be furnished.

,t;tpz;zg;gj;jpYk; Nkw;fz;l cWjpnkhopapYk; mspf;fg;gl;Ls;s tptuq;fs; rupahdit vdTk;> mit rupahditay;y vd;W fz;lwpag;gl;lhy; jw;NghJ tpz;zg;gpj;Js;s jpU / jpUkjp /

nry;tp ……………………………………. mtu;fSf;F xg;gspf;fg;gl;l gbg;G cjtpj; njhif KOtijAk; muR tpjpf;Fk; ve;j topapYk; jpUg;gpaspf;f ,irfpNwd; vdTk; kdkhu cWjp mspf;fpNwd;.

I solemnly declare that the particulars furnished in the application as well as in this declaration are

correct and if they are found to be false later on, I agree to refund the entire amount of scholarships paid to

Thiru / Selvi / Thirumathi ……………………………………. who has now applied for Scholarship

through whatever means the Government deem proper and fit.

,lk;: ngw;Nwhh; /fhg;ghsupd; ifnahg;gk; Place: Signature of Parent / Guardian.

ehs;: Date:

5

fy;tp epiyaj; jiytuhy; epiwT nra;ag;gl Ntz;baJ

TO BE FILLED BY THE HEAD OF THE INSTITUTION

fy;tp epiyaj; jiytu; Heads of the Institution.

1. khztu; tFg;gpy; Nru;e;j ehs;. Date of which the applicant joined the class this year.

2. ,e;j Mz;by; Nju;T KbAk; khjk;. Month in which the annual examination in the

current year will be over. April - 2019

3. khztu; tpLjpapy; jq;fpg; gapy;gtuh? Where the applicant is residing in the hostel?

m. tpLjpapd; ngau; / Name of the Hostel.

M. tpLjp fy;tp epiyaj;Jld; ,ize;Js;sjh? Whether the hostel is attached to the institution?

,. jdpahu; tpLjpah? ,ytr czT> ciwtplk; toq;fg;gLfpwjh? Whether the hostel is run by the private

management and whether free boarding and

lodging is provided.

<. muR tpLjpah Mk; vdpy; tptuq;fs; mspf;fTk;. Whether the student is staying in the Govt. Hostel.

If so indicate details there for.

(i) Mjp jpuhtplu; eyj;Jiw. Adi-Dravidar Welfare Department.

(ii) gpw;gl;Nlhu; eyj;Jiw. Backward Class Welfare Department.

(iii) kpfg;gpw;gl;Nlhu;> rpWghd;ikapdu; eyj;Jiw. Most Backward Class and Minorities Welfare

Department.

4. khztu; tpLjpapy; Nru;e;j ehs;. Date on which the student joined the hostel.

5. tpLjp fhg;ghsupd; ifnahg;gk;. Signature of the Warden.

6. khztu; ngw;Ws;s tUif tpOf;fhL. Percentage of Attendance obtained by the student.

7. khztu; elj;ij Fwpj;J rhd;wpjo;. Character of the student.

8. khztUf;F fy;tp cjtpj;njhif toq;f gupe;Jiu. Recommendation of the Head of the Institution for

the grant of Scholarship.

6

kj;jpa muR Ngh];l; nkl;upf; fy;tp cjtpj; njhif ngWk; khztu;fSf;F kl;Lk;. cly; CdKw;w ,e;J Mjp jpuhtplu; / goq;Fbapdu; khztu;fSf;fhf $Ljy; rYif.

tpz;zg;gjhuu; cly; CdKw;wtuh? Mk; / ,y;iy

Mk; vdpy; gpd;tUtdtw;wpy; nghUj;jkhdij bf; ( ) nra;aTk;

1. ghu;itf; FiwT / Low Vision ( )

2. fhJ Nfl;gjpy; FiwAs;sth; / Deaf ( )

3. njhO Nehapy; ,Ue;J kPz;ltu;fs; / recovered from

leprosy.

( )

4. kdNehahy; ghjpg;gile;jtu;fs; / Physcholagically affected. ( )

5. if> fhy;fs; tsu;r;rpapd;wp topj;Jizahsh;fspd; cjtpAld; fy;Y}upf;Fr; nry;gtu; / Orthopedically

handicapped going to college with the help of a guide.

( )

6. if> fhy;fs; tsu;r;rpf; Fiwthy; CdKw;W fy;Y}upAld; ,ize;j tpLjpapy; jq;fpapUg;gtu;fs; / Orthopedically

disabled studying in institution run for physically challenged

person as hosteller attached to the institution.

( )

7. %is tsu;r;rp Fd;wpatu;fSf;fhd rpwg;G gapw;rp ngWgtu;fs; / Special coaching for mentally retarded person.

( )

NkNy tupir vz; (5)-y; Fwpg;gpl;Ls;s topj;Jizahsh;fs; cjtpAld; fy;Y}hpf;F nry;gth;fshf ,Ue;jhy;.

1. topj;Jizahshpd; ngah; / Guide Name 2. Kfthp / Address

topj;Jizahsupd; ifnahg;gk; / Guide Signature

Nkw;fhZk; nghUs;fspy; nghUj;jkhdtw;Wf;F cjtp kUj;Jt mYtyu; (Civil Assistant

Surgeon) epiyf;F Fiwahj muR kUj;Jt mYtyuplkpUe;J rhd;wpjo; ngw;W ,izf;f Ntz;Lk;.

NkNy tupir vz; (5) kw;Wk; (6)-y; nra;jpUe;jhy; tpz;zg;gjhuupd; jw;Nghija KO cUt

epow;glj;jpid FwpaPl;Lj; jhspy; ,izf;f Ntz;Lk;.

7

rhpghh;g;G gl;bay; / Check List

Gifg;glk; / Photocopy ,ilepWj;jk; ,Ug;gpd; ,ilepWj;j rhd;wpjo; / Break Certificate

rhjprhd;W / Community Certificate kjpg;ngz; rhd;Wfs; / Mark

Certificate

tUkhdr;rhd;W / Income Certificate tq;fp fzf;F Gj;jf Kjy; gf;f efy; / kpd;dD jPh;it gw;W chpikf; fl;lis gbtk; / Whether ECS credit

mandate form enclosed? or enclosed

Bank Pass Book First Page Copy.

tUifr; rhd;W / Attendance Certificate

REG. NO. : ……………………….. M.jp.g.e. 74 & 75-1>000-2006-m.fp.m.> GJif

CLASS : I - jkpof muR YEAR : 2018 - 2019 GOVERNMENT OF INDIA Mjpjpuhtplh; kw;Wk; goq;Fbapdh; eyj;Jiw

ADI-DRAVIDAR AND TRIBAL WELFARE DEPARTMENT fy;tp cjtpj; njhif

GjpaJ / GJg;gpj;jy; FwpaPl;Lj;jhs;

1. fy;tp epiyaj;jpd; ngah;> Kfthp

Institution Name and Address. : SACRED HEART COLLEGE (AUTONOMOUS)

TIRUPATTUR - 635 601, VELLORE DIST.

2. (1) gl;bay; ,dj;jth;. Scheduled Caste.

:

(2) fpwpj;Jt kjj;jpw;F khwpa gl;bay; ,dj;jth;. Scheduled Caste Converted to Christianity.

:

(3) goq;Fbapdh; Scheduled Tribes (rk;ke;jg;gl;l FwpaPl;L vz;izf; Fwpg;gpl Ntz;Lk;) (mentioned the correct serial numbers)

:

3. Mz; (M) / ngz; (ng). Boys / Girls

:

4. (m) khztp / khzth; ngah; Students Name

:

(M) gj;jhk; tFg;gpy; Njh;r;rp ngw;w Mz;L Year and Register No. of passing of the 10

th

Public Examination.

:

(,) gjpT vz; Registration Number.

:

5. jha; (m) je;ij / ghJfhtyh; ngah; Name of the Mother / Father / Guardian

:

(a) FLk;g Mz;L tUkhdk;. Family yearly income.

:

6. epue;ju Kfthp Permanent Address.

:

7. nrd;w Mz;L gbj;j tFg;G, cjtpj; njhif ngw;w gbg;Gg; gphptpd; tptuk;:- Class studied in previous year particulars of

the course for which scholarship received.

(m) (1) Nky;epiyg; gbg;G /

Higher Secondary Class

:

STUDENT ID :

201804010ADW00

2

(2) gl;lg;gbg;G / Degree Course. (3) gl;l Nkw;gbg;G / Post Graduate Course. (4) njhopw;gbg;G / Professional Course (5) njhopy;El;gg; gbg;G / Polytechnic Course (6) rhd;wpjo; gbg;G / Certificate Course.

(M) nrd;w Mz;L gapd;w gbg;G. (1) 1Mk; Mz;L / 1

st Year

(2) 2Mk; Mz;L / 2nd

Year (3) 3Mk; Mz;L / 3

rd Year

(4) 4Mk; Mz;L / 4th


th Year

(,) nrd;w Mz;L tpLjpapy; Nrh;e;j ehs;. Date on which the applicant joined the

hostel last year.

8. ,e;j Mz;L gbf;Fk; gbg;G kw;Wk; Mz;L. Course studying at present and the year of study.

(m) ghlg;gphpT (Kf;fpag; ghlg;gphpT Fwpg;gpLf) / Subject

(M) gapYk; Mz;L (1) 1Mk; Mz;L / 1

st Year

(2) 2Mk; Mz;L / 2nd


rd Year :

(4) 4Mk; Mz;L / 4th


th Year

9. ,e;j Mz;L fy;Y}hp Jtq;fpa ehs;. College re-opening date for the year

khjk; / Month

Mz;L / Year

10.

tpLjpapy; Nrh;e;j ehs; / Joined the Hostel.

khjk; / Month

11 tpLjp tifg;ghL / Classification of Hostel.

(1). mq;fPfhpf;fg;gl;l jdpahh; tpLjp (,ytr czT kw;Wk; ciwAs;). approved or recognized private hostel (free food and accommodation).

(2). mq;fPfhpf;fg;gl;l jdpahh; tpLjp (czT kw;Wk; ciwAs;Sf;fhf fl;lzk; tR+ypf;fg;gLfpwJ).

recognized private hostel (fees collected for food & accommodation).

(3). Mjpjpuhtplh; eyj;Jiw tpLjp Adi Dravidar Welfare Department Hostel.

(4). gpw;gl;Nlhh; eyj;Jiw tpLjp Backward Department Hostel.

1 8

2 0 1 8

0 6

3

(5). kpfTk; gpw;gl;Nlhh; kw;Wk; rpWghd;ikapdh; eyj;Jiw tpLjp. (MBC and Minority Welfare Department Hostel).

(6). fy;tp epWtdj;Jld; ,ize;j tpLjp (nghUj;jkhd vz;fis Fwpg;gplTk;) cly; CdKw;w ,e;J Mjpjpuhtplh; / goq;Fbapdh; khzt / khztpah;fSf;fhd $Ljy; rYif. (Note appropriate number). Additional connection for

Physically disabled HAD / Tribal Boys / Girls.

12. Njh;T KbAk; khjk; / Exam closure Month

Mz;L / Year

13. fle;j Mz;L fy;tp cjtpj; njhif ve;j khjk; tiu toq;fg;gl;lJ. Till which month last year Scholarship was sanctioned.

14. cjtpj; njhif ,e;j Mz;by; ve;j khjj;jpypUe;J toq;fg;gl Ntz;Lk;. / From which month this year

Scholarship has to be sanctioned.

15. khzth; Njitahd tUif tpOf;fhL ngw;Ws;shuh? Does the student attained needed attendance percentage?

Mk; ,y;iy

16. tpz;zg;gjhuh; cly; CdKw;wtuh? Whether the applicant of physically disabled.

Mk; ,y;iy

Mk; vdpy; nghUj;jkhdtw;iw bf; ( ) nra;aTk;. if yes tick ( ) the suitable

(m). ghh;itf; FiwT / Low vision

(M). Nfl;Fk; jpwd; Fiwte;jth; / Deaf

(,). njhONehapy; ,Ue;J kPz;lth; / recovered from leprosy

(<). kdNehahy; ghjpg;gile;jth; / Physcholagically affected

(c). if> fhy;fs; tsh;r;rpFd;wp topj; Jizahsh; cjtpAld; fy;Y}hpf;Fr; nry;gth; / Orthopedically

handicapped going to college with the help of a guide.

(C). if> fhy;fs; tsh;r;rpf; Fiwthy; CdKw;w fy;Y}hpAld; ,ize;j tpLjpapy; jq;fp gapy;gth; /

Orthopedically disabled studying in institution run for

physically challenged person as hosteller attached to the

institution

(v) %is tsh;r;rp Fd;wpath;fSf;fhd rpwg;Gg; gapw;rp ngWgth; / Special coaching for mentally retarded person.

17. khzthpd; tq;fp fzf;F vz;. Student Bank Account Number. :

1. tq;fp ngah; / Bank Name :

0 4

2 0 1 9

0 4

0 6

4

2. tq;fp fpis / Bank Branch :

3. MICR Code / MICR FwpaPL :

4. IFSC Code / IFSC FwpaPL :

5. tq;fp fzf;F Gj;jfj;jpd; Kjy; gf;f efy; / ,izf;fg;gl;Ls;sJ my;yJ kpd;dD jPh;it gw;W chpikf; fl;lis gbtk; / enclosed Bank

Pass Book First Page Copy or ECS credit mandate form

enclosed?


6. kpd;dD jPh;it / Njrpa kpd;dD epjp ghpkhw;wk; / RTGS Kiwapy; fy;tp cjtpj; njhifia Nrkpg;Gf; fzf;fpy; Nrh;f;f khzthpd; Nrkpg;G fzf;F guhkhpf;fg;gLk; tq;fp Core Banking solution trjp mspf;fg;gl;l tq;fpah?

To Facilitate ECS / NEFT / RTGS Transactions

whether the Bank is CBS enabled?


7. khzthpd; njhiyNgrp / miyNgrp vz;. Student Phone / Cell Number :

khzth; ………………………………………………….. ghjpg;gpdhy; cly; CdKw;wth; vd;Wk; khzth; fy;Y}hpAld; ,ize;j tpLjpapy; jq;fp gapy;fpwhh; / topj;Jizahsh; cjtpAld; fy;Y}hpf;F te;J nry;fpwhh; / %is tsh;r;rp Fiwe;jth;fSf;fhd rpwg;Gg; gapw;rp ngWgth; vd;Wk; rhd;wspf;fpNwd;. chpa rhd;Wfs; ,izf;fg;gl;L rhpghh;f;fg;gl;lJ.

Certified that the students ……………………………………………..……….. defect is physically

challenged and is studying in the institution as hosteller attached to the institution coming to

institution with the help of a give / receiving special training for mentally retarded person. Due certificate

are enclosed and verified.

18. fy;tp epiyaj; jiyth; ghpe;Jiu: kj;jpa / khepy muR cjtpj; njhif toq;Fk; tpjpKiwfSf;F cl;gl;L khzth; / khztpah; GJg;gpj;jy; cjtpj; njhif ngw jFjp cilath; vdTk; khzth; / khztpaUf;F cjtpj; njhif GJg;gpj;J toq;fyhk; vdTk; ghpe;Jiu nra;fpNwd;.

18. Recommendation of Head of Institution:- Certified that the student is eligible for renewal

scholarship amount subject to central / State Government rules and the students in recommended for

sanction of renewal scholarship.

fy;tp epiyaj; jiythpd; ifnahg;gk; mYtyf Kj;jpiu.

Principal Signature with Seal

the following documents (xerox copy) should be …

Documents