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RASHTRIYA SANSKRIT SANSTHAN

(Deemed University) 56-57, Institutional Area, Janak Puri, New Delhi-110058


Affix attested Passport size photograph

Application for Scholarship

1.

Name of the Student (In Capital letters)

2.

Gender Tick in the relevant box


Male

Female

3. 4. 5. 6.

Fathers / Husbands Name Date of Birth and age on 01.10.2011 Class, in which the student is studying Stream Tick in the relevant box Subjects taken

Class

Year

I,II,III

Modern

Traditional

7. 8. Whether Sanskrit has been offered as a : Major Subject Tick in the relevant box Full Name & Address of the Institution / : University in which the student is studying or doing research work Yes

No

9.

10. Name of the Institution and full address of : Head of Department / Principal / Director or the authority to whom the cheque may be sent including PIN code and also mobile no. / email 11. Whether you belong to (i) S.C (ii) S.T : (iii) O.B.C. (iv) Handicapped (v) Female (if yes, Please attach copy of certificate issued by Competent Authority in case of (i) to (iv). 12. Complete Residential / Postal address to : which the intimation / correspondence can be sent (Please give phone no. and email id if available)

13. Particulars of examinations passed including latest qualifying examination:


Please use additional sheet if required in the same format

Name of the Examination Year of examination passed passing body

Class/Div. and overall %age of marks

Marks in Sanskrit as a Major Subject


Total Obtained Percentage

14. 1.

For Research Students only Whether student has been registered for Ph. D/ Vidyavaridhi course? If so, please furnish i. Registration No. and date of : registration ii. Please furnish copy of admission and letter of joining Ph.D / Vidyavaridhi Name of the Research Guide with Full Residential Address/Phone : No./Email Id./ Mobile No.

2.

* Note :- (1)Applications for 9th and 10th standard must be counter signed by the concerned District Education Officer. (2) No column of the application form should be left blank, which may be liable for rejection of the application form. 15. Declaration I hereby declare that all the information given by me in this application form and documents submitted by me in support of this application are true to the best of my knowledge and belief. My mark sheet is duly attested by Competent Authority. I also declare that in case I am selected for the Scholarship applied for, I shall devote my full time to approved course of study/research and that I shall not undertake any other paid work or receive any other Scholarship or any other grant from any source during the tenure of this Scholarship.

Date

:.

Place :. SIGNATURE ( ) Name of the candidate

Recommendation of the forwarding authority.


(Head of Deptt./Competent authority of the University in the case of Reasearch student and Head of the Department/ Head of Institution / Prinicpal of the Institution in case of the student of other course of studies)

Certified that________________________________is a regular student /research Scholar in Name of applicant _____________________________________________________________________________ Name of the university / institution and address in full As per the records, the date of admission and enrolment number of the student to the above Course is as under:Class to which Enrolment No Academic Session Date of admission admitted

Date : Signature of Head of Deptt. /Head of Institution/Principal with official seal Place:.

Countersignatures of District Education Officer (in case of students of 9th & 10th standard) Request to the forwarding authority: Forwarding authorities are requested to accord top priority in forwarding the application so that the eligible students do not miss the opportunity of being considered for Scholarship due to non receipt of application on time.
IMPORTANT INSTUCTIONS FOR APPLICANTS i.) ii.) iii.) iv.) v.) vi.) vii.) viii.) ix.) Application form must be forwarded through Principal/Head of the institution / Head of Department and counter signed by the DEO as the case may be. Marksheet / document must be attested by the Principal / Gazetted Officer / Any Competent Authority. Application form must be signed by the Principal/Head of the Deptt./Head of Institution with seal/Rubber stamp. (They should verify signature of student and entries of the form). In case of Ph.D / Vidyavaridhi students, the registration No. and date be mentioned along with documentary proof. Application must be filled in prescribed form only. Each column should be properly filled up. Students of IInd and IIIrd year of any class can also be applicant for Scholarship The application form must be filled in Hindi or English language only. If the student has taken Sanskrit as a subject, it is necessary to write Sanskrit specifically in the subject column, otherwise the application form will not be entertained. Student must submit advance receipt in the following format immediately to enable the Sansthan to release payment in case he/she is selected for Scholarship. ADVANCE RECEIPT I .received a sum of Rs.(Rupees) Name of candidate from the Vice Chancellor, Rashtriya Sanskrit Sansthan (Deemed University), New Delhi being the Scholarship awarded to me for the year 2011-2012 for the class. Date : (Signature of Candidate)

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