Scholarship Form



SAI VILAYATRAI SCHOLARSHIP SCHEME FOR PROFESSIONAL COURSES

Sai Vilayatrai Charitable Trust, Mumbai a non profit & charitable organization grants educational scholarships every year of an amount ranging upto Rs 20,000/- per year to meritorious & needy students for studying higher professional courses.

Following students are eligible for scholarship:

Studying Engineering, C A, IPCC, CPT, CFA, C S, Pharma, B Arch, MBA (reputed institute with above 70% marks in graduate program), Medicine, BDS.

Also eligible high school students who have scored more than 80% marks in SSC in English medium and are preparing for higher professional courses.

Application for grant of scholarship is to be made in the prescribed form a copy of which can be downloaded from our website . Applications must be always accompanied with attested copies of ALL the enclosures asked in the application form.

For any clarification please contact: p_sainani@.

No phone calls will be accepted.

TRUSTEE

SAI VILAYATRAI SCHOLARSHIP SCHEME FOR PROFESSIONAL COURSES

APPLICATION FORM

| |[pic] |

|- Applying for first time: Yes / No | |

| | |

|If No: | |

|- Give past record of scholarships received: | |

| | |

|Date received: ____________ | |

| | |

|Amount received: Rs. ___________ | |

| | |

| | |

| | |

|PART 1- PERSONAL DATA |

| |Full Name (Surname First): |: |___________________________________________________ |

| |Sex |: |___________________________________________________ |

| |Date of Birth |: |___________________________________________________ |

| |

| |Father’s Name |: |___________________________________________________ |

| |Occupation |: |___________________________________________________ |

| |[If Service: Designation & Name of |: | |

| |organization | | |

| |(Signed copy of recent salary | | |

| |certificate/pay ship) | | |

| |If Business: provide full detail, type, | | |

| |size, sales/year, no of employees, name of | | |

| |firm, no of partners, Net Income/Month, | | |

| |etc. | | |

| |(Provide details on the firms letterhead)] | | |

| |

| |Postal Address |: |___________________________________________________ |

| | | |___________________________________________________ |

| | | |___________________________________________________ |

| | | |___________________________________________________ |

| |Last (most recent) exam passed, date of |: | |

| |passing and marks obtained. (Enclosed mark | | |

| |sheet) | | |

| |The higher-level professional course in |: |___________________________________________________ |

| |which the candidate has received admission | |___________________________________________________ |

| |& when? | | |

| |- Presently in which year/semester. |: | |

| |Current Landline No |: |___________________________________________________ |

| |Current Mobile No |: | |

Email id :

|PART II – EDUCATION DETAILS |

|Sr. |Examination |Name of School / |Major Subjects |Aggregate |Position in Merit |Year Of Passing |Any Awards/Others|

|No | |College/University and Place| |Percentage Marks |List | | |

| | | | | |(If any) | | |

| |XIIth Std / Higher | | | | | | |

| |Secondary | | | | | | |

| | Degree Course | | | | | | |

| |(Final Year) | | | | | | |

| |Higher Exams | | | | | | |

| |Passed semester wise. | | | | | | |

If grades – Give equivalent percent marks and method of grading (Copy of university cicular)

|PART III – FINANCIAL STATUS |

| |Fathers / Guardians Monthly income |: |_______________________________ |

| |Details of family: (Number of members of family) |: | |

|Sr. |Relationship |Name |Age |Occupation |Monthly Income |

| |Mother | | | | |

| |Brother | | | | |

| |Brother | | | | |

| |Sister | | | | |

| |Sister | | | | |

| |Others | | | | |

Any false information about income will blacklist the candidate.

| |If total family income is less then Rs. 10,000/- per/month |: | |

| |what are the other sources for supporting the education of | | |

| |children and monthly expenses of family | | |

| | | | |

| |Any other sources of income/help |: | |

| |(From property) | | |

| | | | |

| |Total family income per month from all sources |: | |

| | | |_______________________________________ |

| |Details of total fees paid |: | |

| |(Attach proof) | |_______________________________________ |

| |Any fees payable during year (Attach proof) |: | |

| | | |_______________________________________ |

| |Whether receiving any other scholarship (please provide |: | |

| |details) | | |

| |(Any false information about income will blacklist the | |_______________________________________ |

| |candidate. ) | | |

| |Whether living in hostel /with family and if in hostel |: | |

| |average monthly hostel expenses (Give proof of payment) | | |

| | | |_______________________________________ |

| |List two References (non relations One must be professor of |: | |

| |college/institute where studying) | | |

|Sr. |Name |Phone No |Occupation |Designation |

|No | | | | |

| | | | | |

| | | | | |

PART IV – VERIFICATION / DECLARATION

I hereby certify that the information furnished above by me is true to the best of my knowledge and belief. Any information found untrue will automatically make me ineligible for the scholarship, forever.

I also agree that grant/continuance of scholarship will depend on my performance and the decision of the Trust in this regard will be Final and not a subject of discussion /adjudication of any kind.

I further declare that I shall treat the scholarship, if granted to me, as interest-free loan, and shall repay the amount to the trust as soon as I start earning.

Place: ___________________________

Date: ____________________________ (Signature of the applicant)

PART V-- LIST OF DOCUMENTS TO BE ATTACHED

|Sr. |Document |Type |

|No | | |

| |Proof of passing 12th class or equivalent examination |Mark sheet. |

| |Proof of admission in higher professional course |Certificate from head of College/Institute where studied/mark sheet of |

| | |professional course. |

| |Proof of payment of fees & Hostel charges (if any) |Fee receipt issued by college/institute on admission |

| |Children of salaried persons (both government and private) should |I Tax Form 16 |

| |enclose latest Form-16, or Income Tax return. | |

| |Children of self-employed persons should enclose latest Tax return.|Income Tax Returns and Sales Tax Returns |

| |Please enclose mark sheet for each semester exam. | |

| |Incomplete forms will not be considered and no correspondence will | |

| |be made in this respect. | |

| |All documents to be certified True Copies attested by SEO or | |

| |similar authority. | |

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

Paste recent passport size photograph

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

SAI VILAYATRAI SAI JIWATSINGH SAI VISHINDAS CHARITABLE TRUST

KAMBAR DARBAR, SHANTILAL MODI RD, KANDIVLI (WEST)

MUMBAI 400067. Email: p_sainani@

/ 65881672

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download