Application for continuation / renewal of award of National Scholarship for persons with disabilities (Annexure B)
PART - B
Application for Continuation / Renewal of award of National Scholarship for Persons with Disabilities (2007-08)
(All information should be given either in English or in Hindi only)
- Name: __________________________________________________
(As in Matriculation certificate / school records) - Address: __________________________________________________
_______________________________________________________
State: _________________Pin: _____________
Tele no.(if any): ____________________ - Date of Birth _________________________
- Sex please specify (M-Male, F-Female): ______________
- (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) - 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
