Application Form: Sggs Engineers' Alumni Association (Seaa)

SGGS ENGINEERS' ALUMNI ASSOCIATION (SEAA)
Sadbhavana Scholarship (Academic Year 2017-18)
Application Form
PART 1: COURSE DETAILS
Registration: Class: Branch:
PART 2: STUDENT PROFILE
First Name: Middle Name: Last Name:

Date of Birth:
Religion: Caste:
Gender:
Student's Present Address:
Student's Permanent Address:
E-mail Address: Phone: Landline:
PART 3: PAST ACADEMIC DETAILS
Name of Exam Board/Institute Percentage of marks obtained Rank Year of Passing
PART 4: FAMILY BACKGROUND AND GROSS FAMILY INCOME
Family member name Age Education Occupation Annual Income

PROVIDE SPECIFIC DETAILS:
House Type: Type of Dwelling: No. of Rooms:
Electric/water connection: Farm land(size): Type(dry/det/irrigated):
Crops: Other assets:
PART 5: OTHER RELEVANT INFORMATION
1. Has brother/sister received any other Scholarships? If yes, give details:

2. Have you applied for scholarship, fees exemption or reduction from government or any other sources?
3. If applied for, has it been granted?
4. If yes, state amount of assistence approved:
5.Have you applied for an education loan from any bank?
6. If yes, amount of loan approved:
PART 6: JUSTIFICATION AND NEED OF SCHOLARSHIP
PART 7: VERIFIED AND ATTESTED DOCUMENTS TO BE ENCLOSED WITH

THE APPLICATION FORM
1. Bonafide certificate showing status of enrolment in college, branch, year:

2. Marksheet for prevoius year examination:
3: CET qualifying marks if applicable and/or admission or seat allotment letters:
4. Salary/pension/income certificate or income tax return or other doucment specifying total annual family income:
5. Receipts for actual expenses incurred for current year:
6. Proof of residence:
Place:
Date: Signature of Applicant Signatute of Patent/Guardian
PART 8: DECLARATIONS TO BE SIGNED FOR THE SADBHAVANA

SCHOLARSHIP
DECLARATION 1: Oath and Pledge

I have read the guidelines for completion of this form. I have submitted all the information and documents to
support my application. I confirm that the information provided in this application is true and correct. If proven
untrue or incorrect, I am aware that financial aid may be denied/discontinued to me or that I may be asked to repay
the scholarship provided to me.
I pledge that upon completing my education and becoming an earning member, I shall support the association by
contributing to the scholarship program. I will keep the association informed of my address and my employment
and my occupational status. I will keep in touch with the association and extend help in fulfillment of its mission.
I also understand that the decision regarding the award of number of scholarships and amount awarded as
scholarship is the exclusive right of the committee appointed by the SEAA, Nanded and I will not argue or plead
against it at any platform.
Place:
Date: Name and Signature of Applicant
DECLARATION 2: Sibling and any other scholarship
I hereby declare that none of my brother/sister has been a beneficiary of this scholarship. Moreover, I also declare
that none of my brother/sister is earning.
I also state on oath that I am not the beneficiary of any other scholarship in the current year neither I ahve applied
for award for any other Government/non-Government scholarship.
Place:
Date: Name and Signature of Applicant
DECLARATION 3: Parent's/Guardian's Income
I Parent/Guardian of hereby declare that the informatio provided in this application by my son/daughter/ward and
that my family's gross income stated in the application is true and correct. If proven untrue or incorrect, I understand
that financial aid may be denied/discontinued to my son/daughter/ward and I may be asked to repay the scholarship
provided.
Place:
Date: Name and Signature of Parent/Guardian
PART 9: COMMITTEE'S REMARKS
(To be completed by the Committee members' only after the student and parent/guardian have completed Part 1 to
Part 8) We have personally verified the information provided by the student and his/her parent/guardian in
this application and the attachments hereto. We confirm that the application is complete, true ans correct to
the best of our knowledge. The student and his/her parent/guardian have signed the oath and pledge. The
student is not related to me or any other member.
Sr.
Point for Verification Remark
No.
1. Do you know the student and his family?
Have you met the student's parents and verified the

family background? Please comment on parent's
2.
education, occupation, family background and gross
family income and worth/assets, if any:
Have you verified theinstitute fees for the current

3.
academic year from the authorities?
Is the student a recipient or assistance from any other

4. source? If so, has the student disclosed this fully in the
application?
5. Have you verified the completeness of the application?
Have you checked whether all the required information

6. is provided along with the documents erquired to access
the student's application?
We RECOMMEND/DO NOT RECOMMEND the student for the award of the "SADBHAVANA
SCHOLARSHIP for the Academic Year 2017-18."
AMOUNT SANCTIONED AS SCHOLARSHIP: ______________________
Member 1 Member 2 Member 3

( Name and Signature ) ( Name and Signature ) ( Name and Signature )
For office use only

Date of receipt:
Date of review:
Record No.

Application Form: Sggs Engineers' Alumni Association (Seaa)

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SGGS ENGINEERS' ALUMNI ASSOCIATION (SEAA)

Sadbhavana Scholarship (Academic Year 2017-18)

PART 1: COURSE DETAILS

Registration: Class: Branch:

PART 2: STUDENT PROFILE

First Name: Middle Name: Last Name:

PART 3: PAST ACADEMIC DETAILS

Name of Exam Board/Institute Percentage of marks obtained Rank Year of Passing

PART 4: FAMILY BACKGROUND AND GROSS FAMILY INCOME

Family member name Age Education Occupation Annual Income

PART 5: OTHER RELEVANT INFORMATION

1. Has brother/sister received any other Scholarships? If yes, give details:

PART 6: JUSTIFICATION AND NEED OF SCHOLARSHIP

PART 7: VERIFIED AND ATTESTED DOCUMENTS TO BE ENCLOSED WITH

1. Bonafide certificate showing status of enrolment in college, branch, year:

PART 8: DECLARATIONS TO BE SIGNED FOR THE SADBHAVANA

DECLARATION 1: Oath and Pledge

DECLARATION 2: Sibling and any other scholarship

DECLARATION 3: Parent's/Guardian's Income

PART 9: COMMITTEE'S REMARKS

Have you met the student's parents and verified the

Have you verified theinstitute fees for the current

Is the student a recipient or assistance from any other

5. Have you verified the completeness of the application?

Have you checked whether all the required information

AMOUNT SANCTIONED AS SCHOLARSHIP: ______________________

Member 1 Member 2 Member 3

For office use only

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