Biswabina Foundation

(A Public Charitable Trust)

M/9, Bidhannagar, P.O.-Midnapore
District- Paschim Medinipur
Pin- 721101* Phone: 03222-263918

Application for Students’ Scholarship for the Year

2023-2024

1. Name of the Applicant: ------------------------------------------------------------------------------------------------------

2. Date of Birth Date--------------Month------------------------------Year-------------------------------------

3. Caste (Put tick mark) Gen. ----------ST----------SC----------OBC------------(Attach Attested Photocopy, if not General)

4. Father’s/Guardian’s Name: ------------------------------------------------------------------------------------------------------

(Mention Relation, in case Guardian is not father or Mother)
5. Residential Address: ------------------------------------------------------------------------------------------------------

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6. Address for Communication: ------------------------------------------------------------------------------------------------------

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7. Mobile No./Phone No.(If not own,

Please mention the Name & Relation of Person) ------------------------------------------------------------------------------------------------------

8. Academic Performance
Sl Name of the Name of Year of Subjects Taken with Marks Total Marks & Division/
Examination Passed the Board/ Passing Percentage Class
Council
Madhyamik Pariksha
or equivalent
Higher Secondary or
Equivalent

1
9. Annual Income of Father/ Mother/Parents: ---------------------------------------------------------------------------------------
(Enclosed Valid Certificate of Income)

10. Whether BPL/APL Card Holder (Enclose Photocopy) --------------------------------------------------------------------------------------

11. Whether Scholarship/s Drawn Previously or Drawing Currently (Govt. or others) --------------------------------------------
(if Yes, Give Details with Photocopies of Relevant Documents)
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12. Mention in short the reason for applying -------------------------------------------------------------------------------------------

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Date: ___________________
Place:___________________
Signature of the Applicant: _______________________________
Signature of Guardian: __________________________________
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(For Office Use only)

Overall Comments
Amount Sanctioned per annum
A/C No, if any

Signature of the Secretary Signature of the President

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Rules & Regulations:
1. Decision of the President of the Trust regarding the award and continuation of the scholarship is final and is to be
abided by all parties.
2. Scholarship may be discontinued at any point of time without any prior intimation/citing any reason, if the
candidate is found to fall short of fulfilling conditions of awarding the scholarship.
3. It will be abiding for all the candidates awarded with Biswarup Scholarship to devote two hours of voluntary
service per week in teaching/giving tuitions to the children from financially backward/ deprived sections of the
society.
4. The amount of the scholarship will be released tentatively by 10th of every month by preferably by A/C payee
cheque or cash.
5. The scholarship has to be renewed every year by submitting photocopies of mark-sheets of yearly/term
examinations.
6. Every beneficiary of the Scholarship will have to remain present in the functions/programmes organized by the
Trust from time to time. Exceptions may be granted in times of exigency only.