Ravina

Download as pdf or txt
Download as pdf or txt
You are on page 1of 3

AZIM PREMJI SCHOLARSHIP

APPLICATION FORM

BASIC DETAILS

Personal Information

First Name : Ravina Last Name : Bariya


Gender : Female Date of Birth : 28/1/2006
Mobile Number : 6267159089 Email Id : lalitabariya518@gmail.com
Aadhaar Number : 861368890626

Communication Address

State : MADHYA PRADESH District : DHAR


Address for : Gram lunhera post dist Pin Code : 454010
Communication dhar m.p

REFERRAL DETAILS

Have you been referred by partners of the Azim Premji Foundation ?


No

EDUCATION DETAILS

Class 12 Details

Year of Passing : 2024 Mode of Education : Regular


State : MADHYA PRADESH District : DHAR
Block : NALCHHA Pin Code : 454010
Name of the School : HSS MODEL SCHOOL Percentage : 62.2%
NALCHHA

Class 10 Details

Year of Passing : 2022 Mode of Education : Regular


State : MADHYA PRADESH District : DHAR
Block : NALCHHA Pin Code : 454010
Name of the School : HS LUNHERA Percentage : 64%
Class 8 Details (Optional)

Year of Passing : Mode of Education :


State : District :
Pin Code : Percentage : %

SOCIO-ECONOMIC DETAILS (Optional)

Are you a specially : No Parental Status :


abled person?
Mother's Name : Father's Name :
Annual Family Income : Religion :
Category Name :

ADMISSION DETAILS

State : MADHYA PRADESH District : DHAR


Name of Institute : Maharaja Bhoj Govt. Course Type : Undergraduate Degree
P.G.Autonomous
College,Dhar
Course Category : Others Other course category : BA
Course Name : BA Course System : Annual
Course Duration(In : 3 Course Start Date : 08/2024
years)
Which year of the : 1
course are you
currently studying?

CONSENT

Azim Premji Foundation (“Foundation”) collects information including Personal Information for the purpose of processing
your application and for awarding (if eligible) scholarship under the Azim Premji Scholarship Programme (“Purpose”).

The personal information (“Personal Information”) that we may collect includes but is not limited to your name,
parents’/guardian’s name, gender, address, mobile number, Aadhaar number, bank account details, academic records,
socio-economic information such as religion, community and family status.

The Personal Information collected from you may be retained by the Foundation for as long as may be required for
fulfilling the Purpose stated herein or as may be required by law. The Foundation uses reasonable data security and
safeguard measures to protect all Personal Information in Foundation’s possession. The Personal Information collected
from you by the Foundation shall not be disclosed to any third party without your consent.

By clicking on “I Agree”; you hereby provide consent to

· To provide your Personal Information for the purposes of Azim Premji Scholarship Programme.

· Cancellation of your scholarship in case this Personal Information is found to be incorrect/false at any time during the
course of this scholarship.

You might also like