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INSPIRE Application Form

The document provides instructions for students at the Indian Institute of Technology Kanpur to apply for the INSPIRE scholarship. It specifies that [1] students pursuing 4-year or 5-year dual degree programs in natural and basic sciences who ranked in the top 10,000 in JEE-AIR are eligible. [2] Students pursuing programs in economics, engineering, or those who have failed courses or have a CPI below 6.0 are not eligible. [3] The application form must be fully completed and signed by the student and parents/guardian by September 5th, 2017.

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kumar singh
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228 views

INSPIRE Application Form

The document provides instructions for students at the Indian Institute of Technology Kanpur to apply for the INSPIRE scholarship. It specifies that [1] students pursuing 4-year or 5-year dual degree programs in natural and basic sciences who ranked in the top 10,000 in JEE-AIR are eligible. [2] Students pursuing programs in economics, engineering, or those who have failed courses or have a CPI below 6.0 are not eligible. [3] The application form must be fully completed and signed by the student and parents/guardian by September 5th, 2017.

Uploaded by

kumar singh
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Indian Institute of Technology Kanpur

Senate Scholarships and Prizes Committee


Instructions for Filling-up the Application Form
for INSPIRE Scholarship

Last Date for Submitting Completed


05th September 2017
Application Form:
Please read the following instructions carefully before filling up the INSPIRE application form.

1. Students pursuing 4-Year BS and 5-Year BS-MS Dual Degree programs in natural and
basic sciences AND have secured rank within top 10,000 in JEE-AIR are eligible to
apply for INSPIRE Scholarship.
2. As per the DST guidelines, the students pursuing BS program in Economics and B.
Tech./Dual-Degree programs in Engineering are NOT eligible to receive INSPIRE
Scholarship.
3. If you have failed in one or more courses or your CPI is below 6.0, then you are NOT
eligible to receive INSPIRE scholarship.
4. In the application form, all the fields must be filled; write N/A if a certain field is not
applicable.
5. Incomplete form will not be accepted; the form must be signed by you and your
parents/guardian.
6. All information stated in the application form must be same as in the supporting
document(s). Any discrepancy will attract disciplinary action including but not limited
to revocation of the scholarship.
7. Please submit the completed INSPIRE Scholarship Application Form in the SSPC
office before 5:00 pm on the last date for submitting the application form mentioned
above and widely advertised through e-mail/notice board.
8. You are also required to submit your latest transcripts/grade report card. The first year
students are required to submit a photocopy of their JEE-AIR card.
9. The student must not be getting any other scholarship either from IIT Kanpur or from
any other external source(s). A student can avail ONLY one scholarship at a time.
10. If you are also applying for MCM Scholarship, you must give your FIRST preference
under Item-11 of the form. In case you are selected for both MCM and INSPIRE
Scholarships, you will be awarded your FIRST preference scholarship.
11. Please sign in the INSPIRE-Register kept at the SSPC office while submitting the form.
12. For any questions related to INSPIRE Scholarship, contact the SSPC office via e-mail
at [email protected] or by calling 6187.

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INDIAN INSTITUTE OF TECHNOLOGY KANPUR
Senate Scholarships and Prizes Committee

Application Form for INSPIRE Scholarship

1. Name of the Student: 2. Roll No.: 14171


BALSANT SHIVANAND TIWARI

3. Programme & Department: 4. Category: (GN, OBC, SC, ST, PH)


BS, PHYSICS GN

5. Your Bank A/C Details: 6. Home Phone: 9631844438

Name of Bank: SBI, IIT KANPUR Mobile No.: 9648083171

A/C No.: 20241916451 E-mail-ID: [email protected]


7. ADHAR Card No.: 620715401032 8. Address: D-316/HALL-9, IITK

9. Parental Details: (Occupation may be Govt. Job/Private Job/Business/Agriculture/


Otherplease specify the occupation if other e.g. doctor, lawyer, teacher, etc.)

Father/Guardian Details Mother Details


Name: KAMALA KANT TIWARI Name: KIRAN DEVI

Highest Education: BA(HONOURS) Highest Education: TENTH

Occupation: AGRICULTURE Occupation: HOUSEWIFE

Mobile No.: 9631844438 Mobile No.: 9631844438

10. Other Scholarship Details (attach documents):


Are you currently receiving any scholarship
NO
from IIT Kanpur or external sources (Yes/No):

If yes, provide details (Name of Scholarship,


Amount, Agency, etc.)

The information/facts provided above are true to the best of our knowledge and belief.

Page | 2
_________________ _________________________ _________________
Students Signature Fathers/Guardians Signature Mothers Signature
Date: Date: Date:

INDIAN INSTITUTE OF TECHNOLOGY KANPUR


Senate Scholarships and Prizes Committee

Application Form for INSPIRE Scholarship

11. MCM Scholarship Status:


Are you applying for MCM Scholarship (Yes/No): Yes
In case you are selected for both MCM and INSPIRE
scholarships, give your FIRST preference*: MCM
*You will be awarded your FIRST preference scholarship.

12. Both you and your parents must sign the following declaration/undertaking.

UNDERTAKING

a) I hereby undertake and certify that the information provided in this form is correct and true
to the best of my knowledge and belief and nothing material has been concealed. I
understand that in the event of any information being found false, misleading or incorrect,
or ineligibility to receive the Merit Cum Means Scholarship is detected during or after
completion of my programme at IIT Kanpur, or any of the personal information furnished
in support thereof is found incorrect, neither I nor my parents/guardian shall have any
objection whatsoever against the actions taken by the IIT Kanpur in the matter, in
accordance with provisions 9.3 and 12.2 of the Ordinance of the IIT Kanpur.

b) We are aware that a student must not be getting any other scholarship either from IIT
Kanpur or from any other external sources. We further declare that I/our ward is not
receiving any scholarship either from IIT Kanpur or from any other external agency during
the academic year 2017-18.

c) My application will be considered complete only after I have signed in the INSPIRE
Register kept in the SSPC office.

________________ _______________________ ________________


Students signature Fathers/Guardians signature Mothers signature
Date: Date: Date:

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For Official Use Only
1 Transcripts/Grade Report Card/JEE-AIR Card submitted (Yes/No):
2 INSPIRE-Register signed by the student (Yes/No):
3 Course(s) with F grade during last two regular semesters:
4 CPI of the student:
Checked By:
Items 1 and 2 (in bold font) to be checked before accepting the form from the student.

Page | 4

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