Academic Year-2024-25 Fresh

Paste recent
Vikash Educational Charitable Trust colour
Nurturing Excellence among Students passport size
APPLICATION FOR FINANCIAL ASSISTANCE (Fresh) photo
Last date of Application: 31.10.2024

Only students reading B.A , BSc., BCom., M.A., M.Sc., M.Com, Diploma, B.Tech
( L.E.), B.Tech, BSc. ( Nursing), BSc.(Ag), Dental & MBBS should apply.
1. Personal Data:
(a) Student’s Name : Aadhar No.:
(in capital letters)
Email Id :
(b) Date of birth: District: Block: Nearest
Town
(c) Father’s Name: Age: Education: Aadhar No :

Father’s Occupation (in detail):

(d). Mother’s Name: Age: Education: Occupation:

(e) Annual income of the whole family:

(Attach copy of Income Certificate / Salary Certificate / Pension Payment Order.)

(f). Community to which belongs: GEN/SC/ST/OBC/Others - Religion:

(g)Brothers and Sisters with age Occupation/ Class in which studying.

Sl.No. Name Age Occupation/Class of Study School/College of study

2. Address: (IN CAPITAL LETTERS)

Present Address: (for correspondence) Permanent address:

PIN: PIN:
Contact Phone Number: Contact Phone Number:
E-mail address: E-mail address:

3. Particulars of Course for which assistance is required:

Year of Rank in Basis of Seat
Name & address of Type of Univer JEE/CET Allotment
Name of Admission Year of
Duration the College / institution sity/ Roll No /DET/ (Free/Payment)
Course & class of Exam
study
Institute Govt./Pvt. Board AIEEE,
NEET etc

(Use separate paper, if required)

4. Academic Record:
Name of the University
Year of Name of Board/University Full Marks % of marks
Examination Registration No./ Roll No.
completion Marks obtained secured
Passed

Matriculation
+2 Arts/Sc/Com
+3 Arts/Sc/Com
Diploma
B.Tech/MBBS

Others

Separate sheet may be used for extracurricular activities.

P.T.O.
5. Mention Source wise amounts of all scholarships received by you last year:

Name Source Amount per year

6. Any other scholarship/Loan applied:

Name Source Amount per year

7. Write in a separate paper, in your own handwriting in minimum 200 words (write up) why you require financial assistance
showingyour family background.

Genuineness of your need and your condition will be known from your write up and if your write-up is not satisfactory, your application will be
rejected.

8. Name, designation/position/ and Addresses with PIN and telephone nos. of 2 persons of standing (not related to you) of your locality, who
know your family well & who will be contacted to get more information about you and your family.

1. 2.

PIN................ PIN.......................
Contact Phone: ............................ Contact Phone: ............................

9. Declaration by the Student:

I hereby declare that the information given above in this application is true and correct to the best of my knowledge and belief. If at any stage
it is found that I have provided any false information, or I am not sincere then my financial assistance will be discontinued and I may be asked to
return the amount immediately.

Further, I solemnly promise that upon completion of my study, I shall return all the amount of assistance without interest received through
the Trust within 5 years for use as similar assistance to other poor and meritorious students.

Name of the Applicant (in capital letters) Signature of Applicant Date

10. Undertaking by the Father/ Mother:
I hereby confirm that the above information furnished by my ward are correct . I shall persuade my ward to return the assistance on his
working within 5 years for use as similar assistance to other needy students. If he/she fails to return, I will return the amount.

Name of Father / Mother Signature of Father / Mother Date

11. Certificate by the College Authorities:

Certified that the above named student is studying in ..................................... class of our college. He/she deserves financial assistance for
completion of the course.( If he/she is getting any other assistance, please mention the source & the amount.)

Signature of Principal (With College Seal) College Phone No:

Name: Designation: Date:

Note to student: Please attach all mark sheets. JEE & NEET Rank Card, Income Certificate, Write Up in your own handwriting & expenditure
estimate. If Father is deceased Mother may undertake to repay the amount.

Address for Communication:

VIKASH EDUCATIONAL CHARITABLE TRUST
‘ROSE DALE’, 139, District Center, Chandrasekharpur, Bhubaneswar-751016
E-mail:[email protected], Website: www.vikas.org.in