NILAYA FOUNDATION SCHOLARSHIP

APPLICATION FORM 2019-2020

Application Number: 190122

Important Notes

1. Make sure that this application is taken from your own online
submission. Please don’t take photo copy of other’s application as we
generate unique id for each and every online submission, which is
printed above in this application..

2. Attach photo copy of last year/semester marks card and attach photo
copy of your fee receipt with this application

4. Please note the application number above and quote it in any future
communications

5. Completed applications to reach us on or before 31st July 2019.

Nilaya Foundation, c/o Gururao Kulkarni, #1077, "Shri Ram", 4th Cross,
9th Main, Srinivas Nagar, BSK 1st Stage, Bangalore - 560050. M- 94480
64123, 99805 41495 (Please call only after 6 pm for any queries).

6. Applications should be sent only through ordinary post

7. For clarifications/questions write e-mail to :

nilaya.foundation@gmail.com AND mahesh.deshpande@gmail.com

Personal Information
Name: Sheshagiri kulkarni
Father's Name: Ashok kulkarni
Native District: Koppal

Correspondence Details
Address:
padmavati nilaya, padmavati colony, Bhagyanagar , Koppal , Karnataka

Phone: 9108229038
Mobile: 9663270183
Email: girishak16@gmail.com

Permanent/Parents' Contact Details

Address:
padmavati nilaya, padmavati colony, Bhagyanagar , Koppal , Karnataka
Phone: 9663270183
Mobile:
Adhaar: 742433771091
Caste: Brahmin
Subcaste: Vaishnava

Reference
Name: Vasudev kulkarniAddress:
chokkasandra, T Dasarahalli , Banglore

PIN: 560057
Mobile: 9242225844

Educational Information
Course: BE II
Institution: National Institute of engineering, Mysore
Year: 2 / 3 sem
Dou you have Physics a major subject in your course: n/a

Fee Details
Amount: 30000
Details: college and tuition fee

Amount: 5000
Details:

Background details
How did you know about Nilaya Scholarship?
I have heard about nilaya foundation through one of my relatives
Why do I need to scholarship?
As I come from a middle class family. I am very interested in academics but we do not have
sufficient economical support to afford education, already we are having bank load. This
scholarship would help a lot if covers my basic education expense. Thank you

Name in Bank account: Sheshagiri kulkarni

Bank: State Bank of India
Bank IFSC Code: SBIN0040914
Account Number: 37833943456
Bank Branch Details: Bhagyanagar branch

Application Questionnaire
1.) How many times you have received the scholarship from Nilaya Foundation ?
Ans: 1. Never
2.) What type family background you have ?
Ans: 1. Family with below average status
3.) What is the annual income of your family ?
Ans: 1. Not enough for educational support
4.) What is the academic score for last year ?
Ans: 3. 85% and above
5.) What is the source of Income ?
Ans: 3. Labor or small scale Agriculture
6.) Who supports your Education to major extent ?
Ans: 3. Father
7.) How did you manage Educational expenses so far ?
Ans: 5. Loans or Borrowings
8.) Have you received any other scholarship ?
Ans: 1. No
9.) Where are you staying for studies ?
Ans: 1. Outside native and college hostel
10.) What is monthly expense for food ?
Ans: 1. More than 1000
11.) How do you commute to your college ?
Ans: 3. Walk because I stay near to college
12.) How did you pay the fees for this academic year ?
Ans: 2. Bank loan
13.) How many institutions /NGOs are supporting you in meeting education needs
Ans: 1. None
14.) What is your average score in academics in the last 3 years or 3 semesters?
Ans: 1. Above 90%
15.) Whether your sibling also applied for this year scholarship ?
Ans: 2. Yes and I have got more percentage than my sibling
16.) How many people are working in your family ?
Ans: 3. Only one working in a small job
17.) How many siblings you have?
Ans: 1. 0

I, ………………………………………………………………… declare that all the details furnished above is

true according to my knowledge . I agree that if any discrepancies found with the details furnished, I
will return the amount obtained by me.

Signature