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ALIGARH EDUCATION ENDOWMENT FUND (AEEF)

SCHOLARSHIP FOR 2014-2015

APPLICATION FORM
Please fill out the form clearly using CAPITAL letters only PASTE A RECENT
Is this in continuation of Award? Y/N ____ If yes? Indicate Year______ Amount_______/year PHOTOGRAPH

Applicant's Full Name

(First Name) (Middle Name) (Last Name)


d d m m y y
Date of Birth

Father's Name...............................................................................Mother's Name................................................................

Nature of employment: Service* Self Employed Nature of employment: Service* Self Employed
* Attach employer's certificate confirming salary with telephone no.

Total Annual Income: ..................................................... Total Annual Income: .....................................................

Applicants monthly income (Other Scholarship/s, Part Time Job etc) Rs.___________ pm.

Owner of house ? Yes No Owner of agricultural land? Yes No

Dependents: No. of Brothers.......................... No. of Sisters....................................Others...............................................

Correspondence Address:
House Number/Name) (Society/Mohalla)

(Street/Locality) (Town/City)

(District) (State) (Pin)

Phone No: ............................................... Mobile..................................... E-mail..........................................................

Academic Record : (Provide details of all education completed till 2010. Attach attested copies of mark sheets)

Examination Board School/College & Year of Division Total Marks Marks %


Address Passing Obtained
Higher Secondary
School (X)
Senior Secondary
School (Inter/XII)
Graduation
I/II/III
Post Graduation I
Other

Course of study during 2013-2014............................................................Subject...............................................................

Institution where studying/admitted.....................................................................................................................................


Agreement:
I have read the guidelines for completion of this form. I have submitted all the information and documents required to
support my application. I confirm that the information provided in this application is true and correct to the best of my
knowledge and belief and that nothing has been concealed. If proven untrue or incorrect, I understand 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 AEEF by contributing
to AEEF for its scholarship program. I shall register as an AEEF scholar. I will keep AEEF informed of my address
and my employment and occupational status. I will keep in touch with AEEF and extend help in fulfillment of its
mission. I shall keep my facilitator informed of my progress and seek his/her advice and counsel at all times.
………………………………………. …………………………………
Signature of Father / Mother / Guardian Signature of Applicant
Remarks of Principal/Administrator of Institution where applicant is studying &
Facilitator/Interviewer

Remarks of Facilitator Remarks of Principal/Administrator of the Institution


where applicant is studying

I interviewed the applicant/visited home/ met the Verified the Applicant’s academic record and income:
parents and found the family circumstances:
(a) Full Time student Y N
a) Same as claimed Y N
(b) Getting Financial Assistance (Rs 300/month or more from
other sources Y N
b) Better Y N
(c) Financial claim is supported by Y N
c) Worse Y N his/her lifestyle in school

d) Recommended Amount: (d) Is this a Govt. School/Institution Y N

Rs……………/month (e) Is this a Govt. aided School/Institution Y N


recognized by DIOS
Signature of facilitator

Name ……………………………………………

Place ……………………………………………. Principal’s Signature and Stamp with Address

Email Address:…………………………………. Email Address:………………………..…………………….

Telephone No: …………………………………. Telephone No: ………………………………………………

Renewal Applications Submission: Please submit the completed Application Form


duly signed by the Principal/Administrator, copies of Mark sheet/s and other
documents to Facilitator who interviewed you for 2013-2014 scholarship award.
Renewal applicants must include a brief statement (100-150 words) describing
how the scholarship award from AEEF helped you in your education.

New Applications Submission through Facilitator: Please submit the completed


Application Form duly signed by the Principal/Administrator, copies of Mark
sheet/s and other documents to Facilitator who provided you the application form.

New Applications Submission online: Scanned copy of completed Application Form


duly signed by the Principal/Administrator should be submitted by email to:
AEEFund@gmail.com. Original Application Form, copies of Mark sheet/s and other
documents should be submitted to Facilitator/Interviewer at the time of
interview.

Note: AEEF prefers that applications are submitted through a facilitator. Please
contact us by email (AEEFund@gmail.com ) to find the name of the facilitator in
your area.

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