TEZPUR UNIVERSITY
APPLICATION FOR SCHOLARSHIP

Sponsored by: _________________________________________________________________
Sanction No & Date: _________________________________________________________________
_________________________________________________________________
1. Name (in block letters) in full: ____________________________________________________
2. a) Programme of Studies: ____________________________________________________
b) Department: ____________________________________________________
c) Class Roll No: ___________________ d) Date of joining ________________
3. Period of claim: From _____________________ to _______________________
4. Scholarship amount: Rs. ________________ (Rupees _________________________
____________________________________________________
5. a) Are you receiving any other Scholarship during the above mentioned period? Yes/No
If yes, please detail: ____________________________________________________
b) Which scholarship would you prefer to receive: ____________________________________

Date: Signature of the applicant
FORWARDING NOTE OF HEAD OF THE DEPARTMENT

The attendance of the student during the period was found satisfactory / not satisfactory and recommended/ not recommended for release of scholarship.

Memo No: _______________________ Head, Department of __________________________
Date: _______________________ (Seal)

OFFICE ORDER

Scholarship money Rs. ________________________ (Rupees ________________________________ _____________________________________________) be paid.

Controller of Examinations
Pre-receipt
Transfer the amount into my SBI A/C No……………………………………………....
Received Rs. ________________________ (Rupees _________________________________________ _______________________________________) in full in cash / vide cheque no ________________ Date _________________