Danish Educational Trust (R) No. 85, Sheriff House, Richmond Road, Next to Karnataka State Hajj Committee Office, Richmond Town, Bangalore – 560025. Phone: 080-4112 1281 Email:
[email protected]
Website: www.danishtrust.co.in
PROFESSIONAL EDUCATION SCHOLARSHIPS - 2013 For students seeking Admission to 1st year in Professional Courses BE, MBBS, BDS, B.Arch, BUMS, BAMS & BHMS On merit basis through CET 2013 only. Last date to submit filled in applications: 15th June 2013 Eligibility Criteria 1. Students who have passed 2nd PUC science or 12th std science and CET 2013 exam securing (a) Medical Rank within 3000 (b) ISM Rank within 10,000 (c) Engineering rank within 30,000. 2. The annual income of parents’/guardian should not be more than Rs.1 Lakh. 3. The student should be eligible & willing to receive ZAKAT funds. 4. Separate funds have been reserved for poor & deserving “SYED” Students. APPLICATION FORM
No.
For Official Use Only Category
Date of Receiving
Date of Interview Please paste here (do not staple ) recent color Passport size Photograph
MED / ISMH / ENGG Status
SANCTIONED / REJECTED / PENDING
Amount Sanctioned Signature of President
STUDENT DETAILS (To be filled up by the Student only in his/her own handwriting) Student Name (in CAPITALS) Gender
Male (
)
Female (
)
Date of Birth :
CET 2013 Hall Ticket No. CET 2013 Ranking
Medical :
Cat-1 ( ) Under which category are you GM ( ) selecting the Seat? Others ( )
ISM :
ENGG :
Cat-2A ( ) Cat-2B ( ) Cat-3A ( ) Cat-3B ( ) Defense ( ) NCC ( ) Sports ( ) If others, kindly specify : _________________________
Are you also seeking the benefit of : Rural Quota - Yes ( ) No ( ) ; Kannada Medium - Yes ( ) No ( ) PES 2013
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DETAILS OF PARENTS’ / GUARDIAN & ANNUAL INCOME Father’s Name Father’s Occupation
Annual Income :
Guardian’s Name (In case of Orphans)
Guardian’s Occupation
Annual Income :
Do you have financial problems ? Loans ( ) Medical Expense ( ) Marriage Expense ( ) Others ( ) DETAILS OF FAMILY MEMBERS – BROTHERS & SISTERS Kindly enter details of your family members. Use “Y” to denote Younger and “E” to denote Elder No.
Relationship
Name
Age
Class Studying / Profession
Example
Brother (Y)
Saif Ahmed
21
3rd Year BSc.
Married (Yes/No) No
1 2 3 4 5 6 ACADEMIC & OTHER DETAILS
Exam Passed
Board (State / ICSE/ CBSE)
Institution Name & Address (Please write the address clearly with PINCODE)
Year of Passing
% of Marks
SSLC / 10th Std
2nd PUC / 12th Std Religion :
Caste :
Medium of Study till 10th Std : Kannada ( )
Place of Birth : English ( )
Urdu ( )
Any achievements, prizes won at school / college ?
PES 2013
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CONTACT DETAILS Full Postal Address ( in CAPITAL letters)
PINCODE :
Taluk :
Phone No.
(with STD Code)
Email ID
:
District :
:
Mobile No :
All attachments listed below are compulsory. Please put a tick () in the brackets to indicate the documents you have attached. Kindly do not attach any original documents. Xerox copy of SSLC / 10th Marks Card
:(
)
Xerox copy of 2nd PUC / 12th Marks Card
:(
)
Xerox copy of CET 2013 Hall Ticket
:(
)
Xerox copy of CET 2013 Marks Card#
:(
)
Xerox copy of Address proof document *
:(
)
Xerox copy of Study Certificate
:(
)
Xerox copy of Caste & Income Certificate : (
)
Please paste here (do not staple ) recent color Passport size Photograph
Note : # Internet Printout of CET results. * Ration Card or Electricity Bill or Water Bill or Identity Card. DECLARATION BY THE STUDENT AND PARENT/GUARDIAN
I hereby agree that all details furnished by me in this form are TRUE. I have not modified / manipulated any details. In case the particulars furnished are found to be incorrect, the organization can initiate suitable legal action against me.
I shall report to the organization as and when decided by the organization and update about my studies and career. I assure that I shall pursue my studies very seriously and become an asset for the community and country.
Date
: __________________
Place
: __________________
_________________________________ Signature of the Student
_________________________________ Signature of the Parent/Guardian
Where to submit the filled in application form ? Filled in application forms must be submitted in person or sent through post or courier on or before 15th June 2013 to the below address only.
Danish Educational Trust (R) No. 85, Sheriff House, Richmond Road, Next to Karnataka State Hajj Committee Office, Richmond Town, Bangalore – 560025. Phone: 080 - 4112 1281. PES 2013
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