HIGHER EDUCATION COMMISSION

H-9, ISLAMABAD (PAKISTAN)

SN H HR ISIO IG E DC T N O M EU AIO C M

Application Form For SAMAA TV scholarship program at Pakistan : Spring / Fall 2009 Session

WWW.HEC.GOV.PK/SAMAA-HRD

Attach Photograph here (Affix 1-Photograph here)

Rs. 200/- Original Bank Draft / Pay Order number: Date: (The Bank Draft / Pay Order, should be drawn in favor of JAAG Broadcasting Systems Pvt Ltd., Name of Bank Branch:

Personal Details
Full Name: Fathers Name:
(as given in Matric/S.S.Certificate)
Computerized National ID Card

No:

Marital status: Single (Tick (one of the following): Federal Capital FATA Date of Birth: Day Month Year Correspondence Address NWFP FANA Punjab AJK

Married

Domicile (City /District) Sindh Rural

(Give both):

Sindh Urban Balochistan

Age on (13-02-2010):
(Where you want to receive letters form HEC):

City: Permanent Address (if different form the above Correspondence address):

City: Telephone No. (Office) E-Mail Address (COMPULSARY):

Note:

(Residence)

(Personal Cell):

Do not use CAPITAL LETTERS FOR E-MAIL. Most of the future correspondence will be done using e-mail address, Do not change your e-mail address, and frequently check your e-mails.

Average monthly income of Father/ Guardian:

(From all resources (proof is to be attached))

Monthly electricity Bill (Rs):

(Most Recent bill)

Monthly Gas Bill (Rs):

(Most Recent bill)

Number of Siblings (excluding yourself):

t Recent bill)

Monthly Telephone Bill (Rs):

(Mos

(Tick (one of the following):

Your position in last class: Below 20 (at Bachelors level) Out of total class size of

Top 5

Top 10

Top 20

Academic Details
Note: Candidates must fill division/percentage or CGPA whichever is applicable in the respective examination and as per their certificates/degrees). In Column %age of Marks means that you have to give the actual percentage e.g. if your percentage becomes 60.52. You need to write down this actual percentage with decimal figures also. Do not round of your percentage, give exact number in two digits after decimal.
CGPA. (as mentione d in your final Transcrip t/ Degree) Marks obtained . (as mention ed in your final Transcrip t/ Degree) Out of (Total)

Education al Level

Name of Degree / Certificat e

Year of Passin g

Institution /Board University

Major Subjects

Grade/ Div. (as mentione d in you Final Year Certificat e/ Degree)

%age. (as mentione d in your final Transcrip t/ Degree)

SSC/O-level

HSC/A-level

Bachelors Any Other

Current Enrollment Status in the public sector university (Master in Mass Communications, Journalism or Media Studies in Spring / Fall 2009 Session): Name of University

1. 2. 3. 4. 5. 6. 7.

(Currently studying in Master of Mass Communication, Journalism or Media Studies) Attach copy University Card

Date of joining of classes

(Enrolled in Spring / Fall 2009 Session)
Attach copy of enrollment slip

Name of Head of the Department

(Department of Mass Communication, Journalism or Media Studies)

Official Designation of Head of the Department

(Department of Mass Communication)

Official Phone Number Official E-mail address

of the Head of the Department (Mass Communication, Journalism or Media Studies) of the Head of the Department (Mass Communication, Journalism or Media Studies)

Signature of Head of the Department

(Department of Mass Communication, Journalism or Media Studies)

8.

Stamp and Verified by the Head of the Department

(Department of Mass Communication, Journalism or Media Studies)

9.

Date of verification

Your Personal Blogs Details: Website (mention the web link

/website address)

Personal Pages (attach the prints

of personal blog pages with this form)

YES

NO

Your personal Bank account, used for transaction (in city of your current enrollment):

1. 2. 3. 4. 5. 6.

Name of Account Holder (Account Title) Complete Personal Bank Account Number Name of Bank Name of Bank Branch. (for example NBP Blue Area branch) Bank Code Postal Address of Bank

Undertaking I solemnly verify that the particulars listed above are correct to the best of my knowledge. In case any misrepresentation is identified by HEC/ SAMAA TV Pvt Limited Pakistan at any stage, my scholarship will immediately be terminated. Consequently I'll be liable to pay back the entire amount, released by HEC/ SAMAA TV Pvt Limited Pakistan under various expenditure heads, against my scholarship (i.e. stipend, Grant to university etc.). Name of Candidate: Signature: _______________________________________ Date: Name of Father/ Guardian: Signature: _______________________________________

Date:

Official use only:

Remarks: Check By: Signature: Date:

Check List of Documents attached with Application Form:

Marks Sheet certificates /Degree/

1. Attested copy of SSC / Equivalent 2. Attested copy of HSC / Equivalent 3. Attested copy of Bachelor Degree/ Equivalent 4. Attested copies of last three months income certificate/salary slip. 5. Verified by legal slips of Father / Guardian 6. Attested copies of CNIC (Self, Father, Mother or Guardian, as applicable) 7. Attested copies of Domicile certificate
(Self, Father, Mother or Guardian, as applicable)

8. Attested copy of B-form.

(as a proof of number of siblings)

9.

Attested copies of last three months Utility Bills (Telephone, Gas & Electricity bills, all three types of bills to be attached)

10. Disability certificate from a recognized hospital (if applicable) 11. Original Bank Draft / Pay Order, of Rs. 200, drawn in favor of
JAAG Broadcasting Systems Pvt Ltd.

12. Attested copy of university/institution card. 13. Attestation of enrolment as full time student from the department head. 14. Attested copy of enrollment slip.