Name of Candidate*

Date of Birth*

Gender*
Gender*MaleFemale

Aadhaar No.*

Parent's Info:

Father's Name *

Occupation

Father's Income / Annum

Aadhaar No.*

Mother's Name *

Occupation

Mother's Income / Annum

Aadhaar No.*

Mobile No.*

Email*

Religion*
Select*HinduChristianMuslimOthers

Community*
Select*FCBCMBCSCSTOthers

State*
Select*Andhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest Bengal

City*

Address For Communication*

Pincode*

Are you a first Graduate
YesNo

If so Details :

Academic Details:

10th std mark sheet

12th std mark sheet

Lateral Entry Marks

Extra Curricular Activities:

Sports

Arts/Music/Others

Are you a Day Scholar
YesNo

Are you a Hostellar
YesNo

Declaration of the Applicant*
I hereby declare that the information provided in the Scholarship form and the enclosures are true, correct and complete to the best of my knowledge. I further declare that if found otherwise, I will be liable to forfeit my seat and/or be removed from the rolls of the institution at whatever stage of study I may be, besides marking me for criminal prosecution.