The Institute of Cost and Management Accountants of Bangladesh

ICMA Bhaban, Nilkhet, Dhaka-1205.

Scholarship Application Form
Instructions: Please fill up the form meticulously & select the Scholarship option from
the following list by giving Tick mark (√) in the box. Point to be noted that an applicant
can apply for only one Scholarship.

1. Name of student (In Block Letter):________________________________________________

2. Father’s Name:_____________________________________________________________________
3. Address: a) Present: ______________________________________________________________
_________________________________________________
b) Permanent: __________________________________________________________
___________________________________________________________

4. Date of Birth: _________________ 5. Father’s Occupation: ________________________

6. Mobile No: __________________ 7. Email address: _______________________________

8. Father’s present address: _________________________________________________________

____________________________________________________________

9. Educational Qualification (Marks Certificates/ Mark Sheet to be attached):

Sl. Name of Passing Div./ Class or Marks Board/ University

No. Examination year GPA/ CGPA
1.
2.
3.
4.
5.

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10. CMA performance/ part qualification:

Sl . No. Level Session Year Subjects passed

*10. Total family income (Annual): Tk.= ___________

12. Number of family members: ______________

13. No of brothers’ and sisters with their ages and occupations, (if any) _________________

___________________________________________________________________________

14. Other scholarship(s) (if any) currently enjoying: _________________________________

_____________________________________
Signature of Applicant (Student)

Date: ___________

Level: __________, Roll No. _____________, Reg. No._________, Section ______, Session ___________

*Guardians income certificate from Union Parishad/ Word Commissioner for

agriculture and business man and salary certificate for service holder to be attached.

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