Application for award of scholarship to fresh students with disabilities Part-B (Annexure A)
PART - B
Application for award of scholarship to fresh students with disabilities(2007-08)
(All information should be given either in English or in Hindi only)
1. Name: _________________________
(As in Matriculation certificate/school records)
2. Address: _____________________________
___________________________
State: _________ Pin: __________
Tele no.(if any): _____________
3. Date of Birth: ___________________
4. Sex please specify (M-Male, F-Female): _________
5. (i) Type of disability (Please specify): __________________
[(1) Orthopaedically Handicapped, (2) Hearing Handicapped, (3) Blindness or Low Vision, (4) Other disabilities e.g. Cerebral Palsy, Mental Retardation Multiple Disabilities, Profound or Severe Hearing Handicapped]
(ii) Percentage of Disability(Please enclose an attested copy of the disability certificate)
6. Educational Qualifications:-
| Examination Passed | Name of the Institution | Name of the Board / University | Major Subjects | Aggregate marks obtained & % thereof * | Class / Division |
|---|---|---|---|---|---|
| Class VIII | |||||
| Matric / Secondary | |||||
| Sr. Secondary / Intermediate | |||||
| Graduation | |||||
| Others |
* In case of grades, please mention equivalent % of marks and also enclose authenticated conversion formula
