9/22/2015 FFEStudentRenewalApplicationForm

OnlineScholarshipApplicationRenewalStudentsFormfor201516(FFEVer.1.7)

FirstName MiddleName LastName(Surname)

Student'sSIDNo:13979
Harikrishna KV

Course: YearorPhase/Term: BE/BTechBranch:

BE 3

CollegeType CollegeName(TypeexactlyasinBonafideCertificate)

BMSCE

Facilitator'sName Facilitator'sIDNo.
PNHiriyannaiah 26

AreyouaHostelite/Dayscholar? DayScholar
Student'sLandlineNo(withSTDCode)
Address
SriRamaKrishnaStudents\'Home#67,JaintempleStreet,
Student'sMobileNo NA
VVpurum,Bangalore560004

City Bangalore EmailID krishnahari784@gmail.com

State Karnataka
PinCode 560004 AlternateEmailID

Address&ContactDetailsofacloseRelativeoftheStudent'sFamily

Relative'sName LAKSHMIKV
Relative'sLandlineNo(withSTDCode) NA
RelationshipwithStudent sister
Address
Relative'sMobileNo 9731591358
#280oppositeujwalconventhopeformcirclehopeform
whitefieldbangalore,NA
EmailID venkataraghavendra19@gmail.com
City bangalore
State Karnataka
PinCode 560066

Parent'sPermanentAddress&ContactDetails

Father'sName VIJAYAKN
Parent'sLandlineNo NA
Address
VijayakN,#1733rdwardbehindShanthinikethanSchool
Parent'sMobileNo 9964579216
Gulurroad,BagepalliChikkaballapurDist.561207

City Bagepalli EmailID NA

State Karnataka
PinCode 561207

Student'sBankAccountDetails

A/cHolder'sName(s) HariKrishnaKV

A/cNumber(Full,withalldigits) 64124553674

BankName SBM BankAddress

Bagepalli,chikkaballapurdistrict561207,,
BranchPhoneNo(withSTDCode) 08150282237

The11characterIFSCCode SBMY004008
City bageppalli

PinCode 561207

Note:Availabilityoftherequiredminimumbalanceintheaccountmustbeensured,otherwise,fundtransferofthescholarshipchequeamounttotheaccount
mayberejected/disallowed

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9/22/2015 FFEStudentRenewalApplicationForm

PreviousYear'sAcademicDetails

OddSemester EvenSemester

%MarksScored SGPA 7.85 %MarksScored SGPA 8.14

Annual Failure/ATKT No
IfYes,Semester
%MarksScored CGPA 8.15
Subject(s) Subject(s)

ImportantInformationforScholarship

AreyoureceivingFullAICTEorOtherTutionFeeWaiverfromtheGovernment? No

AnysignificantchangeintheAnnualIncomeofyourparent's,comparedtolastyear? No

AreyoureceivingaScholarship/FinancialAssistancefromany IfYesHow
othersource(otherthanFFE)?
No Much? Source?

AsperStatementofEstimated Actualamountthatwillbespent
ExpenseDetails(InRupees)
ExpensesprovidedbyyourCollege byyouduringtheyear

CollegeRelatedFees 38500.00 16500.00

Note:DonotincludeexpensesonPC/Laptophere

Hostel&MessCharges 00.00 00.00

TransportCharges 00.00 00.00

Books 00.00 00.00

Note:Donotincludeexpensesonstationeryitemslikexeroxbillsetc.

CollegeUniform 00.00 00.00

Note:Donotincludeexpensesonpersonalclothing/dresseshere

Total 38500.00 16500.00

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9/22/2015 FFEStudentRenewalApplicationForm

SCHOLAROATH,PLEDGEANDDECLARATION
A. AP P LIC AN T S P LEDGEOFFU T U R ES U P P OR T T OFFE

Ihav e co mple t e dt he applicat io nf o r FFEscho lar shipandco nf ir mt hat allt he inf o r mat io n
pr o vide dint he applicat io nist r ue andco r r e ct .

Igiv e co nse nt t o FFEf o r shar ingo f dat ao r o t he r inf o r mat io n(no npe r so nal)f o r pur po se s
suchasgr ant s, f undr aising, ne wsle t t e r , andme dia/ pr e ssr e le ase se t c.

Iagr e e t o r e spo ndt o allFFEco mmunicat io nv iae mailandpho ne inat ime ly manne r .

Iagr e e t o par t icipat e ine v e nt s/ classe s(o nline / classr o o m)ando t he r pr e par at o r y o r o t he r
co ur se st hat may b e o f f e r e db y FFEasar e q uir e me nt o f t he S cho lar shipP r o gr amasandwhe n
t he yar e int r o duce d.

Ialso r e co gnize t hat FFEhasr aise df undsy e ar af t e r y e ar f r o mdo no r sinIndiaandU S t o

p r o v id e scho l ar ship st o st ud e nt sl ike me t o war d sco mp l e t ingt he ir p r o f e ssio nal d e gr e e .

If ur t he r unde r st andt hat FFEwillne e dmo r e f undsinf ut ur e y e ar st o suppo r t mo r e

st ude nt s. Once Ico mple t e my de gr e e , Ie xpe ct t o st ar t o najo b andgr o winmy car e e r and
inco me .

Fo r t he t ime ly suppo r t Iamr e ce iv ingf r o mFFE, andr e co gnizingt he v alue o f do nat io nsf o r
suchacause , Iple dge t o suppo r t t he v isio no f FFEino ne o f t he f o llo wingway s:
1 . Iwil l co nt r ib ut e f undst o sup p o r t at l e ast t wo FFEscho l ar sinmy l if e t ime , AN D/ OR
2 . Iwil l r aise p r iv at e o r co r p o r at e f undst o sup p o r t t wo FFEscho l ar s, AN D/ OR
3 . Iwillhe lpo r ganize agr o upo f f o r me r FFEscho lar st o co nduct gr o upf undr aising.

Iagr e e t o sub mit co p ie so f my f inal mar ksshe e t al o ngwit ht he d e gr e e ce r t if icat e o b t aine d t o

FFEupo nmy gr aduat io n.

If ur t he r p l e d ge t hat Iwil l ke e p FFEinf o r me d o f any change sinmy ad d r e ssand e mp l o y me nt

ando ccupat io nalst at usinf ut ur e ye ar s.

Ialso unde r st andt hat f o r r e ce iv ingt he scho lar ship, Ine e dt o maint ainr e gular co nt act wit h
my Facil it at o r (o nat l e ast t hr e e o r f o ur o ccasio nsinay e ar ), ke e p him/ he r inf o r me d o f my
p r o gr e ssand se e khis/ he r ad v ice and co unse l at al l t ime s.

HarikrishnaKV

N ame o f Applicant S ignat ur e o f Applicant Dat e

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9/22/2015 FFEStudentRenewalApplicationForm

B. P AR EN T OR GU AR DIAN S DEC LAR AT ION

Ihe r e b y de clar e t hat t he inf o r mat io npr o v ide dint hisapplicat io nb y my so n/ daught e r / war dis
t r ue andco r r e ct . Fo r t he suppo r t t hat my so n/ daught e r / war disr e ce ivingf r o mFFE, I
und e r t ake and p l e d ge t hat my so n/ d aught e r / war d wil l sup p o r t t he missio no f FFEb y
co nt r ib ut ingino ne o r mo r e o f t he t hr e e wayside nt if ie dab o ve .

Ial so und e r t ake t o ke e p FFEinf o r me d ab o ut t he ad d r e ssand e mp l o y me nt st at uso f my

so n/ daught e r / war dat allt ime s.

VIJAYAKN

N ame o f P ar e nt / Guar dian S ignat ur e o f P ar e nt / Guar dian Dat e

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9/22/2015 FFEStudentRenewalApplicationForm

Facebookurl

LinkedInurl

IacknowledgereceiptofthescholarshipamountofRs.15000fortheyear201415fromFoundationforExcellence.

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