DEPARTMENT OF INTERMEDIATE EDUCATION

APPLICATION FOR AWARD OF SCHOLARSHIP UNDER PRATIBHA SCHEME

District
HUMANITIES / SCIENCE
Category opted
Marks secured/Total

Note:- NO REQUEST FOR THE CHANGE OF COMMUNITY / CATEGORY WILL BE

ENTERTAINED AFTER SUBMISSION OF APPLICATION FORM.
THE
AWARD OF THE SCHOLARSHIP WILL BE CONSIDERED ON THE MERIT
IN THE PARTICULAR CATEGORY UNDER WHICH IT IS APPLIED. AS
COMMUNITY CATEGORY IS NON-TRANSFERABLE, IT SHOULD BE
CAREFULLY SELECTED WHERE CANDIDATE IS ELIGIBLE UNDER MORE
THAN ONE CATEGORY FROM AMONG SC/ST/BC/PH/ MINORITY/OC/
WOMEN
INSTRUCTIONS TO THE APPLICANT:
1)

Read carefully the instructions before filling the form.

2)

On the performance in the intermediate Public Examination/CBSE X & XII /

ICSE-X / ISC XII.

3)

Under which quota Pratibha Scholarship Desired: SC/ST/BC/ Minority/

PH/OC/Women,

4)

To quality for the Pratibha Scholarship, the student should have secured
1st class with a minimum of 60% of aggregate marks in the preceding Public
Examination.

5)

If any information is found to be incomplete, the application will be rejected

and no appeals will be considered thereafter.

6)

If the particulars furnished subsequently are found to be false, the

scholarship will be cancelled and the amount paid will be recovered with
interest and additional penalty will also be imposed.

7)

The application should be endorsed and forwarded by the Head of Institution

where the applicant is presently studying.

8)

All necessary attested certificates are to be appended to the application form.

9)

Affix recent passport size photograph in the space provided in the

application form. The photograph should be attested by the Head of the
Institution.

10)

The application shall reach the Commissioner of Intermediate Education,

Opp: Latha Talkies, Nampally, Hyderabad 500 001, Andhra Pradesh,
Superscribing on the cover as Application for Pratibha Scholarship.

Application for PRATIBHA SCHOLARSHIP

Recent passport
size photograph
attested by the
Head of the
Institution

1) Name of the Student in full (in

capital letters)

2) Fathers name (in capital letters)

3) Name of the Guardian (if father is

not alive)

4) Sex (Male / Female)

5) Date of birth

6) Particulars of Examination passed

: IPE / CBSEX & XII / ICSE-X /

ISCXII (strike off whichever is not

applicable

a) Group (Science / Humanities)

b) Register number

c) Month and year of passing

d) Total marks secured

e) Percentage of marks secured

(copy of Marks Memo is to be
enclosed)

f) Whether passed in 1st class in

one attempt or not

7) College/Institution from which the

above examination passed (Full
address of the College with pin
code)

8) SC/ST/Minority/BC/PH (necessary
certificate is to be enclosed)

9)

a) Present postal address with Pin

code

b) Permanent postal address with

pin code

Particulars of Higher study presently pursuing:

10) Name of the college (with full postal
address with Pin code No.)

11) Name of the course and year presently

studying (IIT/MBBS/ B.Tech/ BDS/
B.Sc./ B.Com /BA etc.

12)

a) For Renewals only: State the

year in which the applicant has
been selected for the Award

b) Percentage of marks obtained by

the candidate in the qualifying
exam. (Copy of the memo of marks
should be enclosed

c) Whether passed in 1st class in one

attempt or not

d) Scholarship sanction proceedings

Number with date and the amount
(in the case of renewals)

13) Whether the candidate is in receipt of

any other scholarship, if yes:

a) Name of the Scholarship

b) Amount of the Scholarship

14) Whether
the
student
opts
for
Pratibha scholarship and is he/she
prepared to forego the scholarship
which he/she is presently enjoying
(student is entitled to the above only
one scholarship)

Date:

:
Yes/No

Signature of the candidate

DECLARATION TO BE SIGNED BYTHE CANDIDATE AND PARENT/GUARDIAN

The particulars furnished in this application are true and correct. Further, we
declare that, the information furnished if found to be false or suppressed at any
time; we shall refund the entire scholarship amount to the Government of Andhra
Pradesh, together with interest and penalty imposed in lumpsum.

Signature of Parent/Guardian

Signature of the candidate

CERTIFICATE
(To be issued by the Head of the Institution where he/she now studying after IPE)
It is certified that Mr./Ms _______________________________________ S/o. D/o
___________________________________________

is

bonafide

student

of

this

Institution who is studying _____________________________________ (Course & Year)

during the academic year ________________ with admission No. & Date ____________
The particulars furnished by the candidate are correct as per the records of this
Office.
I have verified the following certificate and attested the copies which are enclosed
herewith:
1.

Marks Memo & Pass Certificate (Inter/CBSE/ICSE)

2.

Pratibha Award Certificate

3.

Caste/Minority category certificate (Except OC)

4.

Physically

Handicapped

Certificate

issued

by

D.M.H.O

Authorized

Arthopedician
5.

Marks Memo of the preceding examination passed (applicable for renewals

only)

Signature of the Head of the Institution (Office Seal)

(the College in which the student is
presently studying)
Place:
Date: