Uttarpara Prerana 1 Registered Under West Bengal Society Act 1961 UTTARPARA

PRERANA
Students Scholarship Application Form Form No. : PRASTUTI/20_ _/_ /_/_/ _/ _/ _/ _/ _/ Under Project: PRASTUTI

Affix Passport/Stamp Size Photograph

Name of the Student (First Name)

(Last Name)

Full Address:

Date of Birth: DD Name of the School Attended: Name of the College Attending:

MM

YYYY

Marks Obtained In Previous Attempted Examinations: Examination Marks Obtained Out Of

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Uttarpara Prerana 2 Registered Under West Bengal Society Act 1961 Fathers / Mothers Name First Name: Last Name:

Occupation:

Earning Members in the Family: Name

Relation

Average Income of Family(Monthly):

List of Books Provided: Sl Title No.

Author

Value

Other Accessories Provided: Sl No.

Item

Value

List of expenses you expect to incur per month: Approximate Figures Tution Fees Other Expenses List of Other financial assistance you will receive (encircle which is applicable): Page | 2

Uttarpara Prerana 3 Registered Under West Bengal Society Act 1961 1. Yes 2. No If yes mention details:

Write in brief (in English / Bengali)

What are your educational and professional goals and objectives? How have you worked in your life to make a positive difference?

. The following items must be attached to this application in order for the application to qualify to be reviewed by the scholarship committee. 1. Photocopies of your mark sheets of previously passed examinations. 2. A reference letter from your school faculty/authority.

STATEMENT OF ACCURACY I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I also consent that my picture may be taken and used for any purpose deemed necessary to promote the Preranas scholarship program. Signature of scholarship applicant: __________________________ Date: ________________ Signature or Thumb Impression of Guardian: (Prerana) ____________________________________ Signature of President

__________________________________ Organization Seal

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