International Institute of Information Technology (I 2 IT) Scholarship Application Form for Reserved Category Students (SC, ST, SBC, DT-VJNT, OBC)
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1 Scholarship Application Form for Reserved Category Students (SC, ST, SBC, DT-VJNT, OBC) PERSONAL DETAILS OF THE STUDENT:- Hope Foundations's Full Name of the Student: (First Name) (Middle Name) (Last Name) Permanent Address of the Student: Temporary Address of the Student: Date of Birth: (DD/MM/YY) Scheme Type (Scholarship / Freeship): Parent's Annual Income of Last Year: Last Year Exam: (H.S.C / Diploma / F.E. / S.E. / T.E.) Last Year Exam Result - Total & Percentage: ( / ) % Total Earned Credits: Currently Studying in Year: (F.E. / S.E. / T.E. / B.E.) Currently Studying in Course: (E&TC / COMP / IT) Student's Category: (SC / ST / SBC / DT-VJNT / OBC) IRN - (Institute Registration Number): (Displayed on College I-Card) CAP Number: (Displayed on DTE Admission Confirmation Letter. i.e. EN / DSE...) Student's (child) No. among brother / sister in family : Mobile Number of the Student: Mobile Number of the Student's Parent:, PARENT'S DETAILS OF THE STUDENT:- Full Name of the Father: Full Name of the Mother: Permanent Address of the Parent: CASTE CERTIFICATE, CASTE VALIDITY & INCOME CERTIFICATE DETAILS:- Caste Certificate No. Date: District Issuing Office: Caste Validity Certy No. Date: District Issuing Office: Income Certificate No. Date: District Issuing Office: BANK AND AADHAR DETAILS OF THE STUDENT:- Bank Name & Branch: Bank Account Number: Bank IFSC Code: Aadhar Number: Is Aadhdhar Number Linked / Seeded with Mentioned Bank A/c.: (Yes / No) P.T.O.
2 Scholarship Application Form for Reserved Category Students (SC, ST, SBC, DT-VJNT, OBC) Note: Infront of submitted document please write 'YES' Infront of not submitted document please write 'NO' Infront of not applicable document please write 'NA' Sr. No. List of Mandatory ( need to be attached along with Application Form in the same sequence only) Submission Filled by Student Verified by Office Clerk 1 Original Income Certificate of Father for the last Financial Year ( ) Parent's Annual Income limit is Rs. 8,00,000/- (Rs. Eight Lakhs Only) * If the father of any candidate is not alive, then the Death Certificate of father and Income Certificate of Mother for the previous financial year need to be attached. 2 Original Undertaking / Indemnity Bond duly signed by the Student and Parent. 3 Original Annexure of Self-Declaration for Self-Attestation by the Student. 4 Self-Attested Photocopy of Admission Acknowledgement Letter. 5 Self-Attested Photocopy of Leaving Certificate. (12 th / Diploma). 6 Self-Attested Photocopy of Domicile Certificate. 7 Self-Attested Photocopy of Ration Card (First and Last Page should be readable). 8 Self-Attested Photocopy of Caste Certificate. 9 Self-Attested Photocopy of Caste Validity Certificate Self-Attested Non-Creamy Layer Certificate. (Validity up to NA for SC & ST Caste) Self-Attested Photocopy of Marksheets. (10th, 12th / Diploma - Final Sem., F.E., S.E., T.E.) Self-Attested Photocopy of Aadhar Card. (Mandatory to be seeded with the Bank A/c.) Self-Attested Photocopy of Aadhar Number Linking form duly singed & stamped by the Bank Authority. Self-Attested Photocopy of Cover Page of the Bank A/c Passbook (should be readable). 15 Self-Attested Photocopy of Hostel Fee Receipt & Bonafide (If Hosteller) 16 Self-Attested Photocopy of GAP Certificate on Rs.100/- Stamp Paper (If Applicable). * I hereby declare that, the above details are correct and authenticated as per records. * I have neither applied for any type of scholarship nor taken benefit of any type of scholarship from any other Institute or Organization. * In case the declaration is found to be untrue, I am aware that my scholarship is liable to be cancelled and whatever punishment would be Implemented in my case I agree to accept the same. Student's Signature with Date Clerk's Signature with Date
3 RCSMSSSY Application Form for Open Category Students PERSONAL DETAILS OF THE STUDENT:- Full Name of the Student: (First Name) (Middle Name) (Last Name) Permanent Address of the Student: Temporary Address of the Student: Date of Birth: (DD/MM/YY) Last Year Exam: (H.S.C / Diploma / F.E. / S.E. / T.E.) Last Year Exam Result - Total & Percentage: ( / ) % Total Earned Credits: Studying in Year: (F.E. / S.E. / T.E. / B.E.) Studying in Course: (E&TC / COMP / IT) IRN - Institute Registration Number: (Displayed on College I-Card) CAP Number: (Displayed on Admission Confirmation Letter. i.e. EN / DSE...) Student's No. in Family : Mobile Number of the Student: Mobile Number of the Student's Parent:, PARENT'S DETAILS OF THE STUDENT:- Full Name of the Father: Full Name of the Mother: Permanent Address of the Parent: Annual Income of the Father (Previous Financial Year) Rs. (In Figure) (Rs. ) (In Words) INCOME & DOMICILE CERTIFICATE DETAILS:- Income Certificate No. Date: District Issuing Office: Domicile Certificate No. Date: District Issuing Office: BANK AND AADHAR DETAILS OF THE STUDENT:- Bank Name & Branch: Bank Account Number: Bank IFSC Code: Aadhar Number: Is Aadhdhar Number Linked / Seeded with Mentioned Bank A/c.: (Yes / No) P.T.O.
4 RCSMSSSY Application Form for Open Category Students Note: Infront of submitted document please write 'YES' Infront of not submitted document please write 'NO' Infront of not applicable document please write 'NA' Sr. No. List of Mandatory ( need to be attached along with Application Form in the same sequence) Original Income Certificate of Father for the last Financial Year ( ) Parent's Annual Income limit is Rs. 8,00,000/- (Rs. Eight Lakhs Only) 1 * If the father of any candidate is not alive then the Death Certificate of father and Income Certificate of Mother for the previous financial year need to be attached. 2 Original Undertaking / Indemnity Bond duly signed by the Student and Parent. 3 Original Annexure of Self-Declaration for Self-Attestation by the Student. Original Authorization Letter from Previous College / Institute that during 4 Diploma Course student has not taken benefit of scholarship. (Applicable only for Direct Second Year Students). 5 Self-Attested Photocopy of Admission Acknowledgement Letter. 6 Self-Attested Photocopy of Leaving Certificate. (12th / Diploma). 7 Self-Attested Photocopy of Domicile Certificate. Self-Attested Photocopy of Ration Card (First and Last Page should be readable). From the A.Y , only first and second child of the family is eligible for 8 the scheme. Fourth child of the family is not eligible to avail benefit of the scheme and third child would not be eligible, if first and second child of the family already have taken benefit of the scheme. Self-Attested Photocopy of Marksheets. (10th, 12th / Diploma - Final Sem., F.E., 9 S.E., T.E.) Self-Attested Photocopy of Aadhar Card. (Mandatory to be seeded with the 10 Bank A/c.) Self-Attested Photocopy of Aadhar Number Linking form duly singed & stamped 11 by the Bank Authority. Self-Attested Photocopy of Cover Page of the Bank A/c Passbook (should be 12 readable). 13 Self-Attested Photocopy of Fee Payment Receipt. 14 Self-Attested Photocopy of GAP Certificate on Rs.100/- Stamp Paper (If Applicable). Submission Filled by Student Verified by Office Clerk * I hereby declare that, the above details are correct and authenticated as per records. * I have neither applied for any type of scholarship nor taken benefit of any type of scholarship from any other Institute or Organization. * In case the declaration is found to be untrue, I am aware that my scholarship is liable to be cancelled and whatever punishment would be Implemented in my case I agree to accept the same. Student's Signature with Date Clerk's Signature with Date
5 DPDVNBY Application Form for Open Category Hostel Students PERSONAL DETAILS OF THE STUDENT:- Full Name of the Student: (First Name) (Middle Name) (Last Name) Permanent Address of the Student: Temporary Address of the Student: Date of Birth: (DD/MM/YY) Last Year Exam: (H.S.C / Diploma / F.E. / S.E. / T.E.) Last Year Exam Result - Total & Percentage: ( / ) % Total Earned Credits: Studying in Year: (F.E. / S.E. / T.E. / B.E.) Studying in Course: (E&TC / COMP / IT) IRN - Institute Registration Number: (Displayed on College I-Card) CAP Number: (Displayed on Admission Confirmation Letter. i.e. EN / DSE...) Student's No. in Family : Mobile Number of the Student: Mobile Number of the Student's Parent:, PARENT'S DETAILS OF THE STUDENT:- Full Name of the Father: Full Name of the Mother: Permanent Address of the Parent: Annual Income of the Father (Previous Financial Year) Rs. (In Figure) (Rs. ) (In Words) INCOME & DOMICILE CERTIFICATE DETAILS:- Income Certificate No. Date: District Issuing Office: Domicile Certificate No. Date: District Issuing Office: BANK AND AADHAR DETAILS OF THE STUDENT:- Bank Name & Branch: Bank Account Number: Bank IFSC Code: Aadhar Number: Is Aadhdhar Number Linked / Seeded with Mentioned Bank A/c.: (Yes / No) P.T.O.
6 DPDVNBY Application Form for Open Category Hostel Students Note: Infront of submitted document please write 'YES' Infront of not submitted document please write 'NO' Infront of not applicable document please write 'NA' Sr. No. 1 2 List of Mandatory ( need to be attached along with Application Form in the same sequence) Original Small Land Holder Certificate OR Original Registered Labour Certificate. Original Bonafide Certificate for Hosteller. (Form available on web portal.) OR Original Registered Notarized Rent Agreement (Applicable for students, who are not staying in College / Institute s Hostel). 3 Self-Attested Photocopy of Income Certificate of the F.Y Self-Attested Photocopy of Parent s Aadhar Card. 5 Self-Attested Photocopy of Hostel Fee Payment Receipt. Submission Filled by Student Verified by Office Clerk * I hereby declare that, the above details are correct and authenticated as per records. * I have neither applied for any type of scholarship nor taken benefit of any type of scholarship from any other Institute or Organization. * In case the declaration is found to be untrue, I am aware that my scholarship is liable to be cancelled and whatever punishment would be Implemented in my case I agree to accept the same. Student's Signature with Date Clerk's Signature with Date
7 Scholarship Application Form for Minority Community Students (Muslim, Sikh, Buddhist, Christian, Parsi, Jain & Jews) PERSONAL DETAILS OF THE STUDENT:- Full Name of the Student: (First Name) (Middle Name) (Last Name) Permanent Address of the Student: Temporary Address of the Student: Date of Birth: (DD/MM/YY) Scheme Type (Scholarship / Freeship): Parent's Annual Income of Last Year: Last Year Exam: (H.S.C / Diploma / F.E. / S.E. / T.E.) Last Year Exam Result - Total & Percentage: ( / ) % Total Earned Credits: Currently Studying in Year: (F.E. / S.E. / T.E. / B.E.) Currently Studying in Course: (E&TC / COMP / IT) Student's Category: (SC / ST / SBC / DT-VJNT / OBC) IRN - (Institute Registration Number): (Displayed on College I-Card) CAP Number: (Displayed on DTE Admission Confirmation Letter. i.e. EN / DSE...) Student's (child) No. among brother / sister in family : Mobile Number of the Student: Mobile Number of the Student's Parent:, PARENT'S DETAILS OF THE STUDENT:- Full Name of the Father: Full Name of the Mother: Permanent Address of the Parent: CASTE CERTIFICATE, CASTE VALIDITY & INCOME CERTIFICATE DETAILS:- Caste Certificate No. Date: District Issuing Office: Caste Validity Certy No. Date: District Issuing Office: Income Certificate No. Date: District Issuing Office: BANK AND AADHAR DETAILS OF THE STUDENT:- Bank Name & Branch: Bank Account Number: Bank IFSC Code: Aadhar Number: Is Aadhdhar Number Linked / Seeded with Mentioned Bank A/c.: (Yes / No) P.T.O.
8 Scholarship Application Form for Minority Community Students (Muslim, Sikh, Buddhist, Christian, Parsi, Jain & Jews) Note: Infront of submitted document please write 'YES' Infront of not submitted document please write 'NO' Infront of not applicable document please write 'NA' Sr. No. 1 List of Mandatory ( need to be attached along with Application Form in the same sequence only) Original Income Certificate of Father for the last Financial Year ( ) Parent's Annual Income limit is Rs. 6,00,000/- (Rs. Six Lakhs Only) * If the father of any candidate is not alive then the Death Certificate of father and Income Certificate of Mother for the previous financial year need to be attached. 2 Minority Declaration in the form of Affidavit on Rs. 100/- Stamp Paper. 3 Original Annexure of Self-Declaration for Self-Attestation by the Student. 4 Self-Attested Photocopy of Admission Acknowledgement Letter. 5 Self-Attested Photocopy of Leaving Certificate. (12th / Diploma). 6 Self-Attested Photocopy of Domicile Certificate. Self-Attested Photocopy of Ration Card (First and Last Page should be 7 readable). Self-Attested Photocopy of Marksheets. (10th, 12th / Diploma - Final Sem., F.E., 8 S.E., T.E.) Self-Attested Photocopy of Aadhar Card. (Mandatory to be linked with the Bank 9 A/c.) Self-Attested Photocopy of Aadhar Number Linking form duly singed & stamped 10 by the Bank Authority. Self-Attested Photocopy of Cover Page of the Bank A/c Passbook (should be 11 readable) 12 Self-Attested Photocopy of Fee Payment Receipt. Submission Filled by Student Verified by Office Clerk 13 Self-Attested Photocopy of GAP Certificate in the form of affidavit on Rs.100/- Stamp Paper (If Applicable). * I hereby declare that, the above details are correct and authenticated as per records. * I have neither applied for any type of scholarship nor taken benefit of any type of scholarship from any other Institute or Organization. * In case the declaration is found to be untrue, I am aware that my scholarship is liable to be cancelled and whatever punishment would be Implemented in my case I agree to accept the same. Student's Signature with Date Clerk's Signature with Date
9 Scholarship Application Form for Merit-Cum-Means Minority Community Students (Muslim, Sikh, Buddhist, Christian, Parsi, Jain & Jews) PERSONAL DETAILS OF THE STUDENT:- Full Name of the Student: (First Name) (Middle Name) (Last Name) Permanent Address of the Student: Temporary Address of the Student: Date of Birth: (DD/MM/YY) Scheme Type (Scholarship / Freeship): Parent's Annual Income of Last Year: Last Year Exam: (H.S.C / Diploma / F.E. / S.E. / T.E.) Last Year Exam Result - Total & Percentage: ( / ) % Total Earned Credits: Currently Studying in Year: (F.E. / S.E. / T.E. / B.E.) Currently Studying in Course: (E&TC / COMP / IT) Student's Category: (SC / ST / SBC / DT-VJNT / OBC) IRN - (Institute Registration Number): (Displayed on College I-Card) CAP Number: (Displayed on DTE Admission Confirmation Letter. i.e. EN / DSE...) Student's (child) No. among brother / sister in family : Mobile Number of the Student: Mobile Number of the Student's Parent:, PARENT'S DETAILS OF THE STUDENT:- Full Name of the Father: Full Name of the Mother: Permanent Address of the Parent: CASTE CERTIFICATE, CASTE VALIDITY & INCOME CERTIFICATE DETAILS:- Caste Certificate No. Date: District Issuing Office: Caste Validity Certy No. Date: District Issuing Office: Income Certificate No. Date: District Issuing Office: BANK AND AADHAR DETAILS OF THE STUDENT:- Bank Name & Branch: Bank Account Number: Bank IFSC Code: Aadhar Number: Is Aadhdhar Number Linked / Seeded with Mentioned Bank A/c.: (Yes / No) P.T.O.
10 Scholarship Application Form for Merit-Cum-Means Minority Community Students (Muslim, Sikh, Buddhist, Christian, Parsi, Jain & Jews) Note: Infront of submitted document please write 'YES' Infront of not submitted document please write 'NO' Infront of not applicable document please write 'NA' Sr. No. 1 List of Mandatory ( need to be attached along with Application Form in the same sequence only) Original Income Certificate of Father for the last Financial Year ( ) Parent's Annual Income limit is Rs. 2,50,000/- (Rs. Two Lakhs Fifty Thousand Only) * If the father of any candidate is not alive then the Death Certificate of father and Income Certificate of Mother for the previous financial year need to be attached. 2 Minority Declaration in the form of Affidavit on Rs. 100/- Stamp Paper. 3 Original Annexure of Self-Declaration for Self-Attestation by the Student. 4 Self-Attested Photocopy of Admission Acknowledgement Letter. 5 Self-Attested Photocopy of Leaving Certificate. (12th / Diploma). 6 Self-Attested Photocopy of Domicile Certificate. 7 Self-Attested Photocopy of Ration Card (First and Last Page should be readable). Self-Attested Photocopy of Marksheets. (10th, 12th / Diploma - Final Sem., F.E., 8 S.E., T.E.) Self-Attested Photocopy of Aadhar Card. (Mandatory to be linked with the Bank 9 A/c.) Self-Attested Photocopy of Aadhar Number Linking form duly singed & stamped by 10 the Bank Authority. Self-Attested Photocopy of Cover Page of the Bank A/c Passbook (should be 11 readable) 12 Self-Attested Photocopy of Fee Payment Receipt. 13 Self-Attested Photocopy of GAP Certificate in the form of affidavit on Rs.100/- Stamp Paper (If Applicable). Submission Filled by Student Verified by Office Clerk * I hereby declare that, the above details are correct and authenticated as per records. * I have neither applied for any type of scholarship nor taken benefit of any type of scholarship from any other Institute or Organization. * In case the declaration is found to be untrue, I am aware that my scholarship is liable to be cancelled and whatever punishment would be Implemented in my case I agree to accept the same. Student's Signature with Date Clerk's Signature with Date
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