PSG TECH ALUMNI ASSOCIATION

Application for Scholarship

Date:
Roll No: Name:

Date of Birth: Admission by Merit / Management quota (tick)

Diploma / Degree programme with branch & Year:

Hosteller / Day Scholar (tick) Room No. in case of Hosteller

Mobile Phone No. :

Course fees payable to college for 2020 -21 (with split-up): Rs.

SCHOLARSHIP AMOUNT REQUESTED: Rs.

FAMILY PARTICULARS

Details Father Mother

Name

Profession

Office Address

Phone No.

Monthly Income

Other income, per month

Details of other family members, their professions and incomes:

P T O:

:2:
ACADEMIC PERFORMANCE:

DETAILS SSLC HSC DIPLOMA

School / College studied

Marks Scored (%)

Semester I II III IV V VI VII VIII IX X

Average Marks / CGPA

Details of Subjects failed, if

any ( Redo / Re earn)

Residential Address:

Declaration

I am agreeing with the above statement details mentioned are true.

Signature of the Student Signature of the Parent

Recommended by (with remarks, if any)

Hostel Warden Tutor HOD

(For Hosteller)
___________________________________________________________________________
For Office Use

Name of the Scholarship :___________________________

Sanctioned Scholarship Amount :Rs.________________________
Sanctioned Loan Amount :Rs.________________________
Date of Issue & Cheque No :