FAEA : Scholarship 2023-24

Application Form

* Confirmation Code: 202755698

Personal Details

Name (as it appears in your

*  SONALI MONDOL
SSLC/SSC certificate)

* Mother's Name Pratibha Mondal

* Father's Name Bipen Mondal
Email-ID sonalimondol8436@gmail.com
* Gender FEMALE * Date of Birth 31-Mar-2002
* Complete Permanent Address *
Address for Communication
(with Home State/City)
Randhuni para, Raghunath pur, Kaliy
Randhuni para, Raghunath pur, Kaliy

Dinajpur Uttar
Dinajpur Uttar
RAIGANJ
RAIGANJ
WEST BENGAL-733129
WEST BENGAL-733129
Alternate Mobile No./
* Mobile No. 8436952415  
Telephone No.
Fax No. Aadhar No. 797555099832

Social Details
If SC/ST/OBC, please
* Category SC SC
specify
Do you have BPL Card? NO
Do you belong to Below
* YES * If yes, give the BPL Card
Poverty Line (BPL) Category?
No.
Do you have a physical or
Do you belong to a Religious NO
* None * sensory disability?
Minority?
If yes, please specify
* Who was the first person to complete Matriculation (upto class 10) in your immediate family? Siblings
* Father's Education Level Middle * Mother's Education Level Senior School
* Father Occupation Driver * Father's Income 80000
* Mother Occupation Housewife * Mother's Income 2000
Are you presently getting any State Government Scholarship/other scholarship/fee concession/financial help for
pursuing Degree Course?(Yes/No)*: YES
*
Which Scholarship are you getting? Please give details: SVMCM
Please mention the approximate amount of Scholarship you are getting?:Rs.60000
What is your approximate total fee expenditure per year (including course fee and hostel fee)? Please write the
*
minimum funds you require per year?: Rs.200000

Educational Background
Class XIIth School/Diploma Raiganj Coronation High Name of the Board(Class West Bengal Council of Higher
* *
Institute Name? school XII/Diploma)? Secondary Education
 * Name of the City/ Town/ RAIGANJ
Village in which your
Which type of school did you Class XII
* Government School/Diploma Institute
study in?
was located?
If other, please specify
Class XII/Diploma - Was
Class XII/Diploma Medium of
* Indian language * it a residential (boarding) NO
instruction
school

Academic Background
* Year of passing Class X 2018 * Class X percentage 93.29
Year of passing Class Class XII/Diploma
* 2020 * Science
XII/Diploma Exam subject
* Class XII/Diploma percentage: 95.2%
Class for Basis of Percentage Marks Entered: 12th
Note: Select 11th class onlyif result is awaited for class 12th (Students whose results of class 12th are still awaited
may also apply on the basis of 11th Class marks.)
Present Course Pursuing B.sc nursing
* Are you presently pursuing any Course (Graduation/Engineering/Diploma/PG Etc)? YES
if Yes, provide the following information:
Pursuing Currently you are In Year 2023-24, you
Name of the College City State Degree/Course studying in the year will be in which
Name (Course Year) (course year)

West Bengal
West
Government College Kolkata West Bengal III IV
Bengal
of Nursing

* Proposed Course of Study Medicine if others, please specify

Why do you want to join this course?(not more than 200 words):
I want to serve the nation as a nurse and also want a job as soon as possible.

Reference Details

* Reference Name #1 Pratibha Mondal * Gender Male

Randhuni para,
* Address for Communication      
Raghunath pur, Kaliy
         
    RAIGANJ WEST BENGAL      
* City/District RAIGANJ * Pin Code 733129
* State West Bengal      
Contact No. with STD Contact No./Mobile No.
* 8436952415  
Code/Mobile No. (i) (ii)
Fax No. Email-ID sonalimondol8436@gmail.com

Reference Name #2 Bipen Mondal Gender Female

Randhuni para,
Address for Communication      
Raghunath pur, Kaliy
         
    WEST BENGAL      
City/District Kolkata Pin Code 733129
State West Bengal      
Contact No. with STD Contact No./Mobile No.
 
Code/Mobile No. (i) (ii)
Fax No. Email-ID
Declaration
I hereby declare that I have verified the details indicated above and I confirm that all the information
submitted above is correct to the best of my knowledge. I will provide documentary evidence in
support of all the above information. If at any stage, if it is found that any of the above information
is incorrect and/or is suppressed, the management of FAEA shall have the right to take penal action
as deemed fit.
Application No.  202755698. Applicated submitted on 24 June 2023 18:56
Place
Date Signature of Applicant

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