1. SCHOLARSHIP APPLICATION FORM
Academic Year
Application Date
College Name
Course Name
Student SSC details
SSC Board
Passing Year SSC Seat Number Marks Obtained
Applicant Details
Applicant Name
Mother’s Name
Date of Birth Is Resident of Maharashtra YES / NO
Caste Category
Caste Sub Caste
Gender Orphan YES / NO Disabled
Is Applicant Salaried YES / NO
Applicant’s Annual income Total Annual Income
Marital Status
Student Prequalifying Details
Last attended School/College/Institute
Last Exam Passed
Last Exam Passes Year Last Exam Marks

2. Institution Details
Subject
College Admission Number Date of Admission
Joining Date
Is Fee Paid? YES /NO
Fee Receipt Number Receipt Date Fee Amount Paid
Quota Management / Government Is studying at night School? YES / NO
Bank Account Details
Bank Name Branch Name
Account Number
Contact Details
Telephone Number Mobile Number
Email Address
Address for Correspondence
Pin-code Taluka District
Parent /Guardian Details
Name
Relation with applicant
Profession Annual Income

3. Hostel Details
Name of the Hostel
Hostel Admission Date Hostel Type
Is Mess Service Available YES / NO Rent per Month
Hostel Address
Pin-code Taluka District
Hostel Contact Details
Telephone Number Mobile Number
Email Address
Documents
Caste Certificate Number Issuing Office
Caste Validity Certificate Number Scrutiny Committee
Income Certificate Number Date of Issue
University Registration Number
DECLARATION
The information furnished by me is complete and correct. I bear the complete responsibility for all the
above information provided.
Applicant’s Signature
Parent’s Signature
Principal’s Signature