HYDERALI SHIHAB THANGAL ACADEMY FOR CIVIL SERVICES
Perinthalmanna, Malappuram Dt., Kerala – 679322 Ph: 6235 577 577, Email: academy@[Link]
DETAILED APPLICATION FORM
HSTACS Scholarship Test Roll No.: ________________________
01· PERSONAL INFORMATION
Full Name : ___________________________________________________________________
Date of Birth : ___________________________ Aadhar Card No : _________________________
Gender : ___________________________ Marital Status : _________________________
Mobile No. : __________________________ WhatsApp No. : _________________________
Email Address : ___________________________________________________________________
District : ___________________________________________________________________
Legislative Constituency : _________________________________________________
Name of Local Body
(Panchayat / Municipality / Corporation): _________________________________________________
Community
(SC/ST/OBC/EWS/General) : _________________________________________________
Father's Name & Profession : _________________________________________________
Mother's Name & Profession : _________________________________________________
Annual Family Income (₹) : _________________________________________________
Do you belong to any minority community notified by the Government of India? (Muslim, Christian,
Sikh, Buddhist, Jain, or Zoroastrian [Parsi])
If Yes, Name of Minority Community : _________________________________________________
Are you a Person with Benchmark Disability (PwBD)? Yes / No : _________________________
(Attach a copy of disability certificate if yes)
Have you previously been a student of HSTACS? Yes / No : _________________________
If Yes: Course _____________________________ Batch Year ______________ Admission No. ___________
02· EDUCATIONAL BACKGROUND
Sl. Examination Subject Mark Year Name of Institution Board/University
No. Passed Secured of
(%) Pass
1 10th or
Equivalent
2 12th or
Equivalent
3 Graduation
4 Post
Graduation
5 PhD (If any)
Additional Certifications / Courses Relevant to Exam: _____________________________________
03· UPSC CIVIL SERVICES EXAM DETAILS
Whether you have ever applied for U.P.S.C. Examination / Recruitment? If yes, mention the year(s):
Preliminary Exam: _______________________ Mains Exam: ___________________________
Interview Attended: ______________________ Optional Subject Chosen: __________________
Other Exams Cleared (UPSC / KPSC / RRB / SSC etc.) :_____________________________________
Employment Details (if any): _____________________________________________________________
04· ACHIEVEMENTS & EXTRACURRICULAR ACTIVITIES
Please give Particulars at the University / State / National Level in respect of:
a) Prizes, Medals, Scholarships, etc. :
b) Sports / NCC / NSS Activities :
c) Leadership Positions Held :
d) Hobbies, Interests & Other Activities :
DECLARATION
I hereby declare that all the information furnished in this application form is true, complete and
correct to the best of my knowledge and belief. I understand that any false or misleading information
may result in the cancellation of my candidature/admission.
Name & Signature of Candidate with Date: