Padala Charitable Trust (PCT)
Educational Scholarship
Program
(Encouraging Brilliance Among the Poor)
NOTE:
1.
Please be advised that, this scholarship
program is intended for poor and merit students only with no bar on caste,
religion, region or gender.
2.
Last date to receive the application is 31st May
3.
Please do not send any documents along
with this application
FOR
OFFICE USE ONLY DO
NOT ENTER ANYTHING IN THIS BOX.
|
Scholar ID: (Created only for selected Applicants) |
Status of Application Approved /
Rejected / Hold |
|
Scholarship Amount : Rs. |
|
1. Applicant’s (First)
Name: Surname
(Last Name):
2. Male/Female: AGE:
Caste / Community:
(Please note
that caste is used for informational purpose only and will not affect your
eligibility in any way)
3. Date of Birth:
Place
of Birth:
4. Permanent Address:
PIN: Phone: Email ID:
5. Address for Correspondence (if different from permanent
address)
PIN: Phone: Email ID:
6. Particulars of education completed:
|
Class |
Name of educational institution & complete address |
%marks |
G/GA/P |
|
6 to 9 |
|
|
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|
Xth |
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Inter /Diploma Diploma |
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Bachelor Deg |
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NOTE: G-Govt.
School/College; GA-Govt.Aided
School/College; P-Private
School/College
7. Details of
course currently studying:
a)
Name of the course joining/joined:
b)
Rank secured in the entrance test if
any:
c) Name
& Address of the Institution admitted in/applied to:
e) Is it a Govt./Govt. Aided/Private Institute :
f) Tuition
fee paid/payable per annum:
8. Details of family members:
|
Member |
Name |
Age |
Education |
Occupation |
Income
p.a in Rs. |
|
Father |
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Mother |
|
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|
|
|
Brother/ Sister |
|
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Brother/ Sister |
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|
Brother/ Sister |
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9. Details
of ASSETS in the family i)
Land (Extent & value):
ii) Do you have Own House / Building / Shop: Yes/No
If Yes, Rental Income per month:
10.
Particulars of financial support you are receiving from the following sources:
Source Amount
in Rs. Per annum
Merit Scholarship (s) :
Caste / Community Scholarships
from Govt :
Other Trusts / Organizations / Individuals :
11.
Estimated expenditure on the course study per annum:
a) Amount in Rs.:
b)
Indicate
below how the total expenditure is proposed to be met: (attach any receipts
from the institution/college)
12. Mention anything
important that you want PCT to know about you and your family:
I affirm that the above information is true. I also pledge
that on completion of my education and getting employment, I shall support
financially the education of at least two bright and poor students.
---------------------------------- --------------------------------
(Name
of the Applicant) (Signature of the Applicant)
--------------------------------- ----------------------------
Place Date
I vouch for the information provided in this application by
my son/ daughter/ ward.
--------------------------------- ---------------------------------------
(Name
of the parent/guardian)
(Signature of the parent/guardian)
--------------------------------- ----------------------------
Place Date