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Form for Renewal of scholars hi^ for 2009-10

Name of the Name of the Address of the Whether Promoted to the Percentage of Remarks regarding &ate and Board from Bank A/c No.
Student Institute Institute with next class and Percentage of Attendance discipline of the which Class 12 Exams with IFSC code
& e-mail-id where Tele ,fax and marks obtained in annual student, including appeared, year of passing in which initial
studying email-id /semesters exams. ragging, etc. and Roll No. scholarship was
received.
Yes / No

Certified that the particulars given above are true.

Signature of the PrincipalIHead of


the lnstitute

To be sent to

Deputy Secretan/ (National Scholarship)


Ministry of Human Resource Development,
Deptt. Of Higher Education,
A.l/W.3, Curzon Road Barracks,
Kasturba Gandhi Marg,
New Delhi-110001.

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