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Application for Claiming Central Sector Scholarship for Top class education for SC / ST students 1. Name of Student : 2. Father’s Name : 3. Name of Program : 4. Date of admission : 5. Caste : 6. Parental nnual !n"ome : Undertaking ! here#$ underta%e that the a#o&e information is "orre"t to the #est of m$ %no'le #elief and if an$ information (ro&ided #$ me is found in"orre"t. ! 'ill (a$ #a"% the s"holarshi( amount. ! am not getting an$ other s"holarshi( either from the state or from an$ other de(artment)ministr$ of go&ernment of !ndia. Student Signature

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Application for Claiming Central Sector Scholarship for Top class education for SC / ST students

1. Name of Student:2. Fathers Name:3. Name of Program:4. Date of admission:5. Caste:6. Parental Annual Income:

UndertakingI hereby undertake that the above information is correct to the best of my knowledge and belief and if any information provided by me is found incorrect. I will pay back the scholarship amount. I am not getting any other scholarship either from the state government or from any other department/ministry of government of India.

Student Signature