SCHOLARSHIP APPLICATION FORM
Academic Year Application Date College Name Course Name
Student SSC details
SSC Board Passing Year SSC Seat Number Marks Obtained
Applicant Details
Applicant Name Mothers Name Date of Birth Caste Category Caste Gender Is Applicant Salaried Applicants Annual income Marital Status YES / NO Total Annual Income Orphan Sub Caste YES / NO Disabled Is Resident of Maharashtra YES / NO
Student Prequalifying Details
Last attended School/College/Institute Last Exam Passed Last Exam Passes Year Last Exam Marks
Institution Details
Subject College Admission Number Joining Date Is Fee Paid? YES /NO Receipt Date Fee Amount Paid Is studying at night School? YES / NO Date of Admission
Fee Receipt Number Quota
Management / Government
Bank Account Details
Bank Name Account Number Branch Name
Contact Details
Telephone Number Email Address Address for Correspondence Mobile Number
Pin-code Parent /Guardian Details Name Relation with applicant Profession
Taluka
District
Annual Income
Hostel Details
Name of the Hostel Hostel Admission Date Is Mess Service Available Hostel Address YES / NO Hostel Type Rent per Month
Pin-code Hostel Contact Details Telephone Number Email Address
Taluka
District
Mobile Number
Documents
Caste Certificate Number Caste Validity Certificate Number Income Certificate Number University Registration Number Issuing Office Scrutiny Committee Date of Issue
DECLARATION
The information furnished by me is complete and correct. I bear the complete responsibility for all the above information provided.
Applicants Signature Parents Signature Principals Signature