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BHEL, TIRUCHIRAPPALLI, CSR, SCHOLARSHIP SCHEME 2012-13

APPLICATION FORMAT

Name of the student:

Phone Numbers: Photo

Name of the parent:

Studying Std, group, year:

If Physically challenged, give details

(copy of certificates to be enclosed)

Name & Address of the Institution

studying at present:

Occupation of Father:

Occupation of Mother:

Full Address:

Community: SC / ST / MBC / BC/ OC

Annual Income of Father:

Annual Income of Mother:

Whether parents are alive, If no

give details:

Are you getting any scholarship,

If yes give details:

If you are a Sports person, give

details.

Signature of the StudentDate:

Note: Attested copy of the Income Certificate signed by Thasildar to be enclosed

Attested copy of the Mark sheets to be enclosed

Attested copy of Community certificate to be enclosed

Attested copy of Sports certificates to be enclosed

Recommendation of the head of Institution studying at present

with seal

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UNDERTAKING BY PARENT SEEKING SCHOLARSHIP FOR HIS/HER CHILD

I, Smt/Shri __________________________ aged ____________Son/Daughter of

Sri___________________________ residing at _______________________

and working as ____________________ seeking scholarship under

Corporate Social Responsibility scheme, BHEL, Tiruchirappalli for my child

Chi/Sow.______________________ studying in class ______________at _____________________________

School /Polytechnic / College solemnly state the following:

1.The particulars furnished by my son / daughter in the application form are true and factual.

2. I shall inculcate good habits and provide a healthy and wholesome atmosphere at my house to enablemy child to pursue his /her study.

3. If at any time the track record of my child or myself becomes questionable, the scholarship granted tomy child may be withdrawn.

Signature of the Parent