Indian Institute of Technology Kanpur

Senate Scholarships and Prizes Committee

Instructions for Filling-up the Application Form
for Merit Cum Means (Full Tuition Fees + Pocket Allowance @ Rs. 11,000/- for
4-year, 5-year program and Full Tuition Fees + Pocket Allowance @ Rs. 10,000/-
for 2-year M.Sc. program students per year) Scholarship for Academic Year
2021-22

Last Date for Submitting Completed

31st January 2022
Application Form:
Please read the following instructions carefully before filling up the MCM application form.

1. A UG student of any category (GEN/OBC/SC/ST/PH) in the 4-year, 5-year, or 2-year

M.Sc. program can receive the MCM scholarship subject to the following conditions:
a) Student should have a CPI of 6.5 or above to receive full MCM scholarship (freeship +
pocket allowance). If the CPI of a student falls below 6.5 (but remains above 6.0),
then the pocket allowance is withdrawn.
b) Total Family Annual Income (TFAI) of the student from all sources should be less
than 6.0 lacs.
c) Student must not have had ‘F’ grade(s) in one or more courses in the last two regular
semesters.
d) The student must not be getting any other scholarship either from IIT Kanpur or from
any other external sources.
2. In the application form, all the fields must be filled; write N/A if a certain field is not
applicable; incomplete form will not be accepted.
3. Please submit one of the following as the proof of income.
a. ITR-Vs
b. Form-16
c. Certificate from the central/state governmental authority.
4. Notarized documents for income proof will not be acceptable.
5. You are also required to submit your latest transcripts/grade report card/AIR/JAM rank
Proof.
6. Any student who has received any Punishment or disciplinary action by Senate / SSAC of
any level including level Zero will not be eligible to receive any scholarship.
7. Please submit the complete scanned MCM application form in pdf format to
sspc@iitk.ac.in before 5:00 pm on the last date.
8. Information stated in the application form must be the same as in the supporting
document.
9. For any questions related to MCM scholarship, contact the SSPC office by calling 0512
2596187.
 INDIAN INSTITUTE OF TECHNOLOGY KANPUR
Senate Scholarships and Prizes Committee

Application Form for

Merit Cum Means (MCM) Scholarship (AY 2021-22)

1. Name of the Student: 2. Roll No.:

3. Programme: 4. Department:

5. CPI/AIR/JAM: 6. Mobile No:

(Till AY 2020-21)

7.Category ( GN, OBC, SC, ST, PH): 8. E-mail-ID:

9. Parental Details: (Occupation may be Govt. Job/Private Job/Business/Agriculture/ Other-

please specify the occupation if other e.g. doctor, lawyer, teacher, etc.)

Father/Guardian Details Mother/Guardian Details

Name: Name:

Occupation: Occupation:

PAN No (if available) PAN No (if available)

Annual Income: Annual Income:

Mobile No.: Mobile No.:

Total Family Annual Income (TFAI):

10. Attachments:
A.) Proof of income attached (tick one or more):
a.) Form-16 (Assessment Year 2021-22)
b.) ITR-Vs (Assessment Year 2021-22)
c.) Valid Certificate from Govt. Official
*Notarized documents for income proof will not be acceptable.

B.) Proof of CPI

C.) Proof of fee receipt (AY 2021-22 1st semester):

11. Other Scholarship Details (attach documents):

Are you currently receiving any scholarship

from IIT Kanpur or external sources (Yes/No):

If yes, provide details (Name of Scholarship,

Amount, Agency, etc.)

12. You must sign the following declaration/undertaking.

UNDERTAKING

a) I hereby undertake and certify that the information provided in this form is correct and true
to the best of my knowledge and belief and nothing material has been concealed. I
understand that in the event of any information being found false, misleading or incorrect,
or ineligibility to receive the MCM Scholarship is detected during or after completion of
my programme at IIT Kanpur, or any of the personal information furnished in support
thereof is found incorrect, neither I nor my parents/guardian shall have any objection
whatsoever against the actions taken by the IIT Kanpur in the matter, in accordance with
provisions 9.3 and 12.2 of the Ordinance of the IIT Kanpur.

b) I further declare, that in the event that I receive any other scholarship/award, and that I am
also found eligible to receive the MCM scholarship, I will choose only one scholarship
and forsake the other scholarship.

________________
Student’s Signature

Date: