G. P.

BIRLA EDUCATIONAL FOUNDATION

G. P. BIRLA SCHOLARSHIP APPLICATION FORM

1 Name of the Applicant : _______________________________

2 Date of Birth : _______________________________
3. Address : _______________________________ Affix
passport size recent
_______________________________ colourphotograph

PIN:_______________________________
4. Phone No. : _______________________________
5. E-mail Address : _______________________________________
6. Name and Contact No. of Father : F _____________________________________
(F)& Mother (M) M_____________________________________
7. Occupation of Father & Mother : F _____________________________________
M ____________________________________
8. Yearly Income of Father & Mother : F _____________________________________
M ____________________________________
9. Marks/Rank obtained in last : Year________Board_________Marks(%)_____
Examinations& School last studied
School_________________________________
10. A brief resume of the applicant : _______________________________________
including particulars of extra
_______________________________________
curricular activities.
_______________________________________
11. Subject of further study and course : _______________________________________
duration.
_______________________________________
12. Name and address of the Institute : _______________________________________
where the applicant will pursue
_______________________________________
higher studies.
_______________________________________
13. Any other information to justify grant : _______________________________________
of Scholarship.
_______________________________________

Signature of the Applicant

____________________
Signature of the Principal
with Rubber Stamp of the
College/School.
 Instructions for Application of Scholarship

The following documents must be submitted to the address mentioned below:

1. A completed copy of the application form attested by the Head of the Institution from
which the Student has passed Class XII or where he has taken admission.

2. Proof of admission (if admission has been taken)at a university or collegein which the
applicant shall pursue higher studies.

3. Copy of academic certificates and grade reports for the last examination.

4. Copy of other certificates for extracurricular achievements.

5. Proof of Income:

i. Copy of Form 16 or Salary Certificate, in case the Father or Mother is in

Employment with Government or Private Sector, or

ii. Copy of Income Tax Return or Certificate from Tahsildars or Councillors, in any
other case.

Address :
“GP Birla Educational Foundation,
78, Syed Amir Ali Avenue, Kolkata - 700019”

Last Date for receipt of application:15th July, 2019