PART-II
CENT VIDYARTHI
(For Common Application Form, Guarantor’s Consent Letter & Acknowledgement-Please fill PART-I)

BASIC INFORMATION

Sl Particulars Details
a. Proposed course of Study

b. Duration of Course Years Full time Part time

c. Name and address of the College / Institution in which the student intends to join.

d. Name of the University/Recognised Authority to which the college/ institute is affiliated.

e. Has the student been admitted into the above College /Institute / University or accepted for the Course? If so, certified copy of admission/ acceptance Letter should be attached
f. Is the applicant attending any college or Institute at present? If so, furnish full particulars.
g. No. of earning members in the Family & their total income.
h. Whether the student has any working experience? If yes, please give details.
i. Whether the student will take up any part-time employment during study? If yes, please give details.
i. Year of retirement of father Guardian (if in service only)

.

CENT VIDYARTHI
STUDENTS ACADEMIC RECORD:
Name of the examination from SSC or equivalent onwards
Name of the School/ College
Medium of instruction
Examination authority
Month & year of passing
Whether passed in the first attempt
Aggregate marks first attempt
Out of total marks
Percentage of marks
Rank/Class/Div obtained
Scholarship/ Prizes won for academic distinction.
(Certified copies of the list of marks of all the above exams should be enclosed)

PARTICULARS OF FINANCIAL REQUIREMENT OF THE COURSE
Studies in India Rs. Studies in abroad Rs.
Admission fee Total fees for ______ per year
Term Fee for ___years Books, stationery, instrument & equipment
Books, stationery, instruments, equipment examination fees Boarding & lodging @ ___________ per year for _____________ years
Boarding & loadging @ Rs.______ per month for ________ years Total i.e. Equivalent in Rs.
Total (enclose evidence) Air passage (one way only)
Total (enclose evidence)

CENT VIDYARTHI

SOURCE OF FINANCE:
1. Non repayable scholarship(s) at Rs._____________ p.a. for ____________ years Rs.__________________
2. Loan scholarship(s) and or other repayable financial assistance from other sources Rs.__________________
3. Contribution of Parent/ Guarding and /or other Members of the family / relatives towards total expenses Rs.__________________
4. Amount of loan required from the bank Rs.__________________
5. Earning of the student(if any) Rs.__________________
Total Rs.__________________

Particulars of Insurance Policy (ies) (In the case of father/ guardian/ applicant only)
Names of the insured Policy No Date Date(s) of Maturity Amount of yearly premium Date of last premium paid

ADDITIONAL INFORMATION TO BE FURNISHED BY STUDENTS UNDERTAKING STUDIES ABROAD
a. Amount of foreign exchange required.
b. Foreign currency
c. Rupee equivalent
d. Have you obtained the necessary passport, /visa etc? Yes/No.(if yes, give reference)
e. Do you intend to take up any part time
employment during the course of studies abroad? If so, give particulars.
f. What are your likely Prospects on your return to India?

DECLARATION: We hereby declare that the information furnished against the foregoing items is true to the best of our knowledge and belief.
We also undertake to inform the bank immediately any change in our employment details, address, telephone number including mobile no. etc. for both local and permanent address,

Signature of Father/Guardian

Place Signature of student

Date Signature of Guarantor (if any)