DIRECTORATE OF HIGHER EDUCATION
GOVERNMENT OF GOA
APPLICATION FORM FOR SCHEME FOR FINANCIAL ASSISTANCE FOR HIGHER EDUCATION/TECHNICAL
EDUCATION IN PROFESSIONAL INSTITUTIONS OF REPUTE IN INDIA
A] Personal Profile:
1. Full Name of the student __________________________________________
2. Address for correspondence :___________________________________________
________________________________________________________________________
________________________________________________________________________
3. Permanent Address___________________________________________________
________________________________________________________________________
________________________________________________________________________
4) Tel.No:______________ Mobile ______________ E-mail ID: ___________________
5) a)Date of birth ___________________ b)Place of birth :____________________
B) (1) Academic Profile:
Educational
qualifications
Name of the
Institution
where studied
Name of the
Board/Univer-
sity
Year of
passing
Percentage
of marks
obtained
Rank
obtained,
if any
Std.X
Std.XII (specify
the stream):
______________
Degree( specify
the stream):
_______________
Reg.No._____
Affix a recent
passport size
photograph
(2) Scholarships / Fellowships received, if any: ________________________
________________________________________________________________________
C] Admission Profile:
1. Course for which admission is confirmed :______________________________
2. Whether the course is recognized by
AICTE/Govt.ofGoa/Govt.of India:______________________
3. Name of the Institution where admission is
confirmed:____________________________________________________________
D] Total Family Income preceeding financial year :________________________
__________________________________________________________________________
I, Mr/Miss__________________________________, hereby, declare that I have made myself aware of the terms and conditions of the Goa Government Scheme for financial assistance for higher education/technical education in professional institutions of repute in India and I promise to abide by
them . I further state that the above information given herein is true to the best of my knowledge and belief. I have not suppressed any relevant information in respect of my application. In the event of any information furnished by me herein, is found to be false or incorrect and/or in the event of any suppression of relevant /necessary data proved against me, I have noted that I would be disqualified from the Scheme and the amount disbursed to me shall become repayable, immediately.
Dated: Signature:
Name:___________________________
N.B. Please attach certified photocopies of all the relevant documents:
a) Marksheets of Std Xth, XIIth & Graduation
b) Family Income Certificate/Form No. 16 issued by
Competent Authority.
c) Domicile/Residential Certificate
d) Birth Certificate/Age Proof
e) Bonafide Certificate.
f) Duly certified Free Structure by the head of Institute where admission is sought/Fee Receipts issued by the institutions.

DECLARATION
DIRECTORATE OF HIGHER EDUCATION
GOVERNMENT OF GOA
JUNTA HOUSE, 2ND LIFT, 5TH FLOOR,
PANAJI-GOA.
SCHEME FOR FINANCIAL ASSISTANCE FOR HIGHER
EDUCATION/TECHNICAL EDUCATION IN PROFESSIONAL
INSTITUTIONS OF REPUTE IN INDIA

1. OBJECTIVE OF THE SCHEME
In recent years Goa has witnessed a sizeable good number of students pursuing their studies in national institutions of repute such as Indian Institute of Technology, Indian Institute of Management, Birla Institute of Technology, etc. Quite often it is observed that these meritorious students find it difficult to meet the expenses involved in pursuing their studies in these institutions. The basic objective of this scheme is therefore, to recognize the merit of such students in general and to provide deserving students financial assistance to continue with their academic pursuits.
2. DETAILS OF THE SCHEME
2.1 The Scheme envisages the selection of all such meritorious students who have sought admissions in the institutions of national repute.
2.2 The Scheme lays down the procedure to be followed for the selection of such meritorious students.
2.3 The scheme will be managed by the Directorate of Higher Education through “HIGHER EDUCATION PROMOTION FUND(HEPF)” that has been established by the government by for grant of Interest Free Loan, Goa Scholars scholarship etc. to eligible candidates.

3. ELIGIBILITY FOR PROVIDING FINANCIAL ASSISTANCE
3.1 Any student seeking financial assistance under the scheme should have been born in Goa and domiciled in Goa for at least fifteen years.
3.2 He/She has passed Std. Xth and Std. XIIth examination from any of the institutions located in Goa as regular students.
3.3 He/she must be below the age of twenty two years on the date of application.
3.4 The benefit of the Scheme shall not be available to those whose family income exceeds Rs. 10.00 lakhs per annum. For subsequent continuation of the financial assistance (renewal cases);the family income should not exceed Rs. 4.50 lakhs per annum”.
3.5 He/she must have obtained admission in any of the following set of institutions:
a) Any of the IITs in India
b) Any of the IIMs in India
c) Any of the BITs in India
3.6 The scheme shall come into operation from academic year 2010-11. However, those of the students who are already enrolled in the institution above and are studying in IInd, IIIrd or IVth year shall also be entitled to receive scholarship from the date of applicability of the scheme on the same terms and conditions.
4. SPECIAL PROVISION FOR SC/ST STUDENTS
Any of the SC/ST students seeking admissions in the Institutions mentioned above, shall be entitled to receive 50% of financial assistance more than that of the General Candidates except for item No.5.1 (2).

5. AMOUNT OF SCHOLARSHIP
5.1 The amount of Financial Assistance provided to the eligible students shall consist of the following components:
1. Refund of fees paid to the institution subject to a maximum of Rs. 1.00 lakh or actual fees whichever is less.
2. A one time grant for purchase of one laptop subject to a maximum of Rs. 50,000/- or actual whichever is less.
3. An amount of Rs. 15,000/- per annum towards purchase of books, stationery, equipments etc.
4. Maintenance allowance consisting of Hotel fees and mess charges @ Rs. 2000/- per month or actual whichever is less.
6. APPLICATION PROCEDURE AND CALENDAR.
Applications under the scheme shall be called from eligible students in the prescribed format on or before 20th June every year. The selection procedure shall be complete before 30th June of that year. Applications received beyond the stipulated dates shall not be considered.
The Scheme would be managed by the DIRECTORATE OF HIGHER EDUCATION.
7. RENEWAL OF SCHOLARSHIP
The scholarship shall be continued in subsequent years only if the students passes the examination conducted by the concerned institutions with not less than 60% of marks or equivalent grade. Concerned students shall communicate to the Directorate of Higher Education in writing about their performance in the qualifying exam.
8. Any student who is the recipient of financial assistance under this scheme shall not be entitled to receive benefits under any other scholarship of Government of Goa.