Application for Scholarship - Sports, Co-curricular and

(Recent colour Extra-curricular Activities (2019)

passport size photo
is compulsory) The filled-in application with relevant documents is to be submitted to the respective
Director/Coordinator on or before 05 December 2019.

(Only final year students (Undergraduate/Postgraduate) are eligible to apply)

1. Name of the Student............................................................................................. Reg.No................................................

Programme/Class/Section ....................................................................... Gender: Male Female

Mobile No.......................................................................... Date of Birth..........................................................................

Email ID (University) ..................................................................... (Personal)...................................................................

Permanent (Home) Address..............................................................................................................................................

..........................................................................................................................................................................................
2. Family Information

Father Mother

Name Name

Education Education

Working Status Yes No Working Status Yes No

Company Name Company Name
/ Occupation / Occupation
Designation Designation

Annual Income Annual Income

3. Academic Information

Academic Year Total No. of Papers No. of Papers Passed Marks (%) Attendance (%)

Semester I

Semester II

Semester III

Semester IV

Semester V

Semester VI

Semester VII

Semester VIII

Semester IX

Aggregate percentage of all semesters

 4. Representing: (tick one activity only)

Centre for Social Action (CSA) National Cadet Corps (NCC) Sports
Student Welfare Office (SWO) Association of Christian Christites (ACC) CAPS
Student Council

Others (Specify).............................................................................................................................................................

Mention key contribution (not less than 75 words) to the association/activities you were associated during the year 2019
Scholarship - Sports, Co-curricular & Extra-curricular (2019)

5. Details of your participation and mention about awards/certificates/prizes won in inter-collegiate level or inter-
university activities at the International/National/State/Regional level. (Attach xerox copies of certificates wherever applicable,
enclose separate page as per the below format, if required)

Position Level (Inter-Collegiate, Inter-University -

Year Activities Event Name
(I, II, III) International/National/State/Regional)

2019

2019

2019

2019

2019

We solemnly declare that the information given herein above is true and correct to the best of our knowledge and
belief. At any stage, it is found that the information given is false/not true, scholarship will be withdrawn.

Date …………...........…...... Student Signature…………......…................……. Parent Signature.....................…........….…….

Checklist: Photograph Attendance Copy (all semesters) Statement of Mark (all semesters)

Co-curricular & Extra-curricular Certificates

 Comments of the Director/Coordinator (Tick the applicable)

REGULARITY Yes No Average

(Punctual and Regular - post event and during the event)

RESPONSIBILITY Yes No Average

Consistently completes assigned duties and tasks

ENTHUSIASM Yes No Average

(Having a positive attitude during the activities)

DEPENDABILITY Yes No Average

(Flexibility in adaptability to any assignment)

ACADEMIC Yes No Average

(Academically performs and maintains attendance)

Scholarship Recommended Yes No

Scholarship - Sports, Co-curricular & Extra-curricular (2019)

Recommended Amount (The amount vary between Rs.2,000 to Rs.10,000)

Comments (if any)…………………………………………………................................................................…………………......………...…

Name .………………………………………............……Signature............................................…..Date. ……………………….........……...

Authorization by Chief Finance Officer Approved Not Approved