Student Application 1

The Godavari Sugar Mills’

Somaiya Grameen Vikas Kendra, Sameerwadi Taluk : Mudhol

Dist : Bagalkot

Pin – 587 316

Phone- (08350) 260046 / 47 / 48 ===================================================

Application for Scholarship under a project

Paste here a passport size colour photo

Help A Child To Study 1. Name of the Student (In capital letters) 2. Name of the course completed:

3. Name of the present course:

4. Name of your parent / guardian 5. Occupation of your parent / guardian

Relation

6. Total annual income of the parent / guardian 7. Permanent Address: House No.

Street Name / Location:

At / Post: Pin code:

Taluk:

District:

Phone No. with STD code (Mention neighbor’s no. with their name if you do not have)

8. Name & Address of the School / College in which he / she studied At / Post: 9. Details of marks obtained in SSLC / II PUC / Degree

Taluk:

Courses (SSLC / II PUC / Degree)

District:

Total marks obtained

Percentage of marks

10. Name & address of present college At / Post:

Signature of the student

Taluk:

District:

Signature with seal of Present college Principal 1