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Student Registration: Create Fresh/Renewal Application

This document is a student registration and scholarship application form that collects personal details of the student such as name, date of birth, gender, contact information, educational qualifications, details of the course being sought including institution and fee details, parent/guardian information including income and address, and a list of required documents to attach including proof of residence, educational qualifications, photograph and bank account details.

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zaheerbc
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© Attribution Non-Commercial (BY-NC)
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Download as PDF, TXT or read online on Scribd
22 views

Student Registration: Create Fresh/Renewal Application

This document is a student registration and scholarship application form that collects personal details of the student such as name, date of birth, gender, contact information, educational qualifications, details of the course being sought including institution and fee details, parent/guardian information including income and address, and a list of required documents to attach including proof of residence, educational qualifications, photograph and bank account details.

Uploaded by

zaheerbc
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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Student Registration

Last Name Name Father's Name Mother's Name User ID Password Confirm Password Gender Date of Birth Contact Mobile No Email Address (Opt.) Secret Question Answer : : : : : : : : : : : Which is your favourite colour? :
N.A. ************* **************

First Name

Middle Name

Create Fresh/Renewal Application


All fields are mandatory unless specified

Scholarship Application Type

Fresh

Renewal

Applicant's Details
Applicant Name Date of Birth State / UT of domicile Academic Year

: : :
Maharashtra

Mother's Name Religion : Nationality Application Date

: :

Muslim

Indian : 13/08/2011

Other
Gender

Male
:
Female

: 2011 - 2012

Details of educational qualification from matriculation / SSLC / SSC onwards


Examination Passed University/Board Main Subjects Year Of Passing Percentage Division/Grade

Add

Cancel

Add

Cancel

Add

Cancel

Details Of Course For Which Scholarship Is Being Sought


If you cannot find your Course Name in the list,please select Others(Please specify) and Enter Name of Course.
XI

Course Level

: Diploma

XII UG PG

Name Of Class/Course

(XI Arts ,BA Etc)

Duration Of Class/Course(Months : ) Please Select Course Year


I

Year of the Course

Last Examination Passed Last Academic Year

: : :
2010

Last Attended School/College/Instit : ute Maximum Marks

Marks Obtained

Percentage

Institution Details
Note : If you cannot find your College Name in the list,please contact the Regional Joint Director Office through college authorities only.
Thane

Name of District

Tal Taluka(Opt.)

Note : Please select the first college in case of repetition of name of colleges. Name of School/College/Instit : ute Where Admitted

Address

Date of Admission

Date of Joining

Contact Details
Telephone No(Opt.)

Mobile No

Email Address(Opt.) :

Fee Details
Course Fee includes Tution Fee,Library Fee,Examination Fee,etc.other than refundable deposits. Item
Admission Fee Tution Fee Library Fee Examination Fee Other than refundable deposits Add Cancel

Fee (Rs.)

Address for Correspondence

Address

Location/Post District Pincode

:
: :
--Select District--

City/Village Taluka State

:
: :
--Select Taluka-Maharashtra

Enter Parent\Guardian Details


Name Parent/Guardian Annual Income Whether address is same as above?

: :

Last Name Middle Name

First Name

Yes

No

Address

Location/Post : District Pincode : :


--Select District--

City/Village Taluka State

:
: :
--Select Taluka-Maharashtra

Permanent Address
Whether address is same as above?

Yes

No

Address

Location/Post : District Pincode : :


--Select District--

City/Village Taluka State

:
: :
--Select Taluka-Maharashtra

Whether Staying in hostel run by the : School/College/Instit ue Whether Staying as paying guest Or In the rented accomodation which : are not the places where parents reside.

Yes No

Yes No

RequiredFieldValidator

Note : After clicking on "Done" button if next page is not displayed, please recheck the application form for error messages.

BANK ACCOUNT DETAILS:


ACCOUNT NO: __________________________________ BANK NAME:________________________________________ BRANCH NAME:__________________________________ MICR CODE:__________________________________

Documents to be Attached
Anexure -I Declaration Of Family Income and Minority Status

Proof Of Permanent Residence - Rations Card / Electricity Bill/Election Card

Attested certificates of Educational Qualifications

Passport sized photograph with signature

Photocopy of the first page of bank passbook, indicating Name,Address and Account Number

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