Documente Academic
Documente Profesional
Documente Cultură
APPLICATIONFORMScholarship2015
Pleasefilluptherequiredinformation.
*Fieldsmarkedwithasteriskaremandatory.
P e rs ona lD e ta ils
1.*
FullNameasitappearsinyourSSLC/SSCcertificate
Mr.
1.b* Mother'sName
2.*
1.c*
CompletePermanentAddress
(withHomeState&City):
Father'sName
*
Home
State/U.T.
Select
SelectCity
* City/District
Ifothers,Specify
* PinCode
2.*
CurrentAddress(Addressfor
Communication)
ClickheretorepeatPermanent
Address
* State/U.T.
Select
SelectCity
* City/District
Ifothers,Specify
* PinCode
3.a* MobileNo.(10digitsonly)
+91
4.
FaxNo.withSTDCode
6.*
Gender
Select
7.*
DateofBirth(DD/MM/YYYY)
Day
Month
3.b
MobileNo.2/
TelephoneNo.
withSTDCode/
5.
EmailAddress
Year
8.*
Category
Select
9.
IfSC/ST/OBC,
pleasespecify
10.*
DoyoubelongtoBelowPoverty
Line(BPL)Category?
Select
11.*
Doyouhave
Select
BPLCard?
Ifyes,givethe
BPLCardNo.
Select
Doyouhavea
physicalor
sensory
13.* disability?
12.*
DoyoubelongtoaReligious
Minority?
Select
Ifyes,please
specify
14.*
WhowasthefirstpersontocompleteMatriculation(uptoclass10)inyour
immediatefamily
15.a* Father'sEducationLevel
Chooseone
Select
15.b*
Mother's
Chooseone
EducationLevel
Educationlevels
Primary1stto5thor6th
Middle7thto8thor9th
Matriculation10thPass
SeniorSchool11thto12thPass
GraduationBA,BSc,orequivalent
PostGraduationMA,MSc,LLb,MBBSorequivalent/graduationintechnicalfield
DoctoralorhigherprofessionaldegreePhD,MPhil,LLM,MS,MDorequivalent
16.* Father'sOccupation
Father's
17.* Income(Rs.
perannum)
SelectFather'sIncome
18.* Mother'sOccupation
Mother's
19.* Income(Rs.
perannum)
SelectMother'sIncome
20.*
22.*
Nameofthe
21.* Board(Class
XII/Diploma)
ClassXIIthSchoolName/Institute
NameDiploma
Whichtypeofschooldidyoustudy
in?
Chooseone
http://www.faeaindia.org/NewApps/Fill_application.asp
Nameofthe
City/Town/
Villageinwhich
yourClassXII Chooseone
School/Diploma
23.*
Insttitutewas
1/2
located
Ifother,please
specify
24.* ClassXIIMediumofinstruction:
Chooseone
Class
XII/Diploma
Wasita
25.*
residential
(boarding)
school
Chooseyear
27.*
Chooseyear
Class
29.* XII/Diploma
subject
Chooseone
Ac a de m ic Ba c k ground
26.* YearofpassingClassX
28.*
YearofpassingClassXII
Exam/Diploma
30.* ClassXII/Diplomapercentage
31.a* Proposedcourseofstudy
ClassX
percentage
%
Choosesubject
%
Choosecourse
ifothers,pleasespecify:
Areyoupresentlypursuingany
31.b Course
Select
*
(Graduation/Engineering/Diploma/PG
Etc)?
32.
Whydoyouwanttojointhis
course?
(notmorethan200words)
(optional)
Re fe re nc e D e ta ils
33.a Reference#1:Name
Gender
Reference#1Address
Choosegender
City/District
State/U.T.
Select
PinCode
ContactNo./MobileNo.#1
FaxNo.
33.b Reference#2:Name
Reference#2Address
ContactNo./
MobileNo.#2
EmailAddress
Gender
City/District
State/U.T.
PinCode
ContactNo./MobileNo.#1
Contact
No./Mobile
No.#2
FaxNo.
EmailAddress
Choosegender
Select
Declaration
IherebydeclarethatIhaveverifiedthedetailsindicatedaboveandIconfirmthatalltheinformationsubmitted
above is correct to the best of my knowledge. I will provide documentary evidence in support of all the above
information. If at any stage, if it is found that any of the above information is incorrect and/or is suppressed, the
managementofFAEAshallhavetherighttotakepenalactionasdeemedfit.
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