UNIVERSITY OF ENGINEERING AND MANAGEMENT
INSTITUTE OF ENGINEERING & MANAGEMENT
Please Tick appropriate Campus (√)
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IEM Newtown Campus
IEM Salt Lake Campus
ALUMNI / STUDENTS’ FINANCIAL AID AND SCHOLARSHIP APPLICATION FORM 2024-2025
1. Name of the Applicant: _______________________________________
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2. i) Department: ii)Year:_ (1st/2nd/3rd/4 /Alumni)
3. iii)Semester: (1st/2nd/3rd/4th/5th/6th/7th/8th/NA)
iv)Enrollment No. : v) Class Roll No.: vi) CGPA: (attach grade cards)
4. Address: _____________________________________________________________________________________
5. (A) i) Father’s Name……………………………………ii) Father’s Annual Income……………
(B) i) Mother’s Name………………………………… ii) Mother’s Annual Income……………
(C) Annual Income from Other Sources…………………………………………………………….
6. Total Annual Family Income (A + B+ C): Rs. …………………………………………...............
7. Category (General/SC/ST/OBC/EWS/Others): ________________ (Self-attested photocopy of cast certificate to be enclosed)
8. Are you receiving any financial help from any other organization (Govt./ Private / Student Credit Card): Put a (√)
(i) No
(ii) Yes If yes, give details: ________________________________________________________________
9. (A) Type of Scholarship (Put a √) :
(i) Single Semester Fees Waiver
(ii) Half Semester Fees Waiver:
(iii) Full Fees Waiver:
(iv) Other financial assistance: (specify)
(B) Reason (Please √): (Supporting documents from competent authority to be enclosed)
(i) Job loss:
(ii) Sudden medical emergency:
(iii) Serious medical emergency:
(iv) Death of earning member:
(v) No family income:
(vi) Others (specify)
10. Provide your reason for scholarship/financial support :
Declaration:
I hereby declare that all the information given above is true to the best of my knowledge. I am not in recipient of any other
Scholarship/Stipend/Financial assistance etc. from any other source. I shall personally be held responsible, if at any stage it is found
that, information(s) is/ are given in this form is/are false /incorrect as per the scholarship scheme, application is liable to be cancelled.
For Existing Student Only: For Alumni Only:
Signature of the student:________________________________ Signature of Alumni:_________________________________________
Name of the Department:________________________________ Department & Year of Passing:_________________________________
Year & Roll Number:___________________________________ Name of the Employer:_______________________________________
Contact Number:_______________________________________ Designation:________________________________________________
E-mail ID:____________________________________________ Contact No.:________________________________________________
E-mail ID:_________________________________________________
