FORMAT OF APPLICATION (Fresh/Renewal)

(Merit-Cum-Means scholarship for students belonging to Minority Communities

for Professional/Technical Course)

FOR OFFICIAL USE ONLY (To be filled by District office)

SI. No. of Year Course Whether approved Fresh/Renewal

application

Affix a self-
attested passport
size photograph

1. Full name (in block letters)

Surname
First Name
Middle
Name

2. Father's name/husband's name:

3. Mother's name:

4. Domicile State/UT (State/UT which the student belongs to)

5. Address for correspondence:

House No.
Mohalla/Street
City/Town/Village
&P.O.
District
State
Pin Code

6. Permanent address [Please enclose residential certificate from concerned state government
authority (Certificate not required to be enclosed for renewal cases if address has not
changed)]

House No.
Mohalla/Street
City/Town/Village
&P.O.
District
State
Pin Code

1
7. Date of birth [Please enclose certificate (certificate not required to be enclosed for renewal
cases)]

D D M M Y Y Y Y

8. Whether male or female: Male Female

9. Religion:

10. Nationality:

11. Details of educational Qualifications from matriculation/SSLC/SSC onwards [Please

enclose certificates attested by a gazetted officer(Certificate not required to be enclosed for
renewal cases )]

Examination University/Board/ Main Year of Percentage Division/

passed Institution/Council subjects Passing marks Class/
of Examination Grade

12. Details of course for which scholarship is being sought :

(i) Name of the technical/professional course:

(ii) Duration of course:

(iii) Academic year:

(iv) Class/Year/Part :

(v) Date of admission in current academic year:

13. Basis of admission in professional/technical course [whether on the basis of qualifying

competitive examination or on other grounds. Please give details (not required to be filled up for
renewal cases)]
Name of Year Rank Counseling Date Select /Reject
Entrance/Competitive
Exam

14. Details of college/institution

(i) Name of the college/institution where admitted:

(ii) Address of college/ institution:

(iii) Telephone no:

(iv) Fax no:

(v) E-mail address:

(vi) Is the college/ institution recognized. If so the name of authority which has recognized
the institution:

(vii) To which university is it affiliated/does it have deemed university status:

2
15. For renewal of scholarship:
(Please enclose certificate/mark sheet attested by a gazetted officer )

Name of Year Marks obtained Full marks % of Promoted

examination marks detained or
passed with held

16. Total Annual course fee. Rs ........................./- (Rupees in words)

[Break up of course fee such as tuition fee, library fee, examination fee etc. other than
refundable deposits (Please enclosed ' Fee receipts)]

SI.No. Item Annual fee

1
2
3
4
5
6
Total

17. Details of bank account of student:

(i) Name of the payee (as in the bank accounts)
(ii) Name of the Bank
(iii) Bank Branch --------------------------------- (full address)
State District Pin
(iv) Branch Code number (Leave one space wherever required)

(v) Bank Account Number (Leave one space wherever required)

(vi) Type of bank Account Saving/Current

(vii) MI CR code of the Bank (Leave one space wherever required)

(viii) Mode of Electronic transfer available in the Bank ECS/ RTGS /NEFT/ CBS /code number (if
any);-

18. Annual Income of parent/guardian of the student: Rs ---------------/- (Rupees in words)

(Specimen form of declaration of annual income is given at Annexure which is to be signed by the
parent/guardian of the student and enclosed along with the application. In case parent/guardian are
employed, income certificated from the employer may also be enclosed)

19. Documents enclosed with the application

(i) Attested certificates of educational qualification as filled up in Para 11 &15
(ii) Income declaration-affidavit on non-judicial stamp paper and income certificated from
the employer
(iii) Proof of permanent residence
(iv) Receipt in acknowledgment of scholarship in the previous year duly countersigned by the
head of the institution
(v) Fees receipts
(vi) Affidavit/Certificate for belonging to minority communities

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20. Declaration:
(i) I hereby declare that information given above is correct.
(ii) I am not availing any other scholarship for this purpose from any other sources.
(iii) I shall abide by the terms and conditions for sanction of the merit-cum other means based
scholarship.
(vi) I undertake, that if at any stage, it is found to the satisfaction of the sanctioning authority in
the Ministry of Minority Affairs that the information given by me is false or if I violate the
terms and conditions of the scholarship, the scholarship sanctioned to me, may be cancelled
and the entire amount of scholarship will be refunded by me or recovered from me, apart
from liability for such penal action as warranted by law.

Signature of the candidate

Date:
Place:

21. Verification/information to be furnished by the Head of institution/ college:

It is certified that the information filled in the above mentioned columns by Shri/Smt/Kumari -------
------------------------------ S/O,D/O,W/O Shri --------------------------------- who is admitted in ----
---------------- course for the academic session --------------- in ------------------------------------------
college is correct. He/she/is a hostler/day scholar of the college.

For Renewal of scholarship:

It is certified that the above mentioned student has passed the ------------------------------------
examination for ---------------------------------- (year) and has attained ------------------- % of marks,

It is also certified that the student has not changed the course of study and/or the institution of the
study for which the scholarship was originally awarded/ has changed the course of study and/ or
institution with prior approval of the state government (please strike out which is not applicable)

Details of bank account of institution/college (For deposit of course fee) :

Name of the payee (as in the bank accounts)
(ii) Name of the Bank
(iii) Bank Branch --------------------------------- (full address)
State District Pin
(iv) Branch Code number (Leave one space wherever required)

(v) Bank Account Number (Leave one space wherever required)

(vi) Type of bank Account Saving/Current

(vii) MI CR code of the Bank (Leave one space wherever required)

(viii) Mode of Electronic transfer available in the Bank ECS/ RTGS /NEFT/ CBS /code number (if
any);-

Signature of head of the institution/college

Date: With official seal

Place:

4
 Annexure -1
Summery of Guidelines for merit cum means scholarship (please read the guidelines and form carefully. Incomplete
form will be rejected)
Eligibility criteria

i) Students, who have got admission in a recognized college to pursue technical/professional courses, on the basis
of a competitive examination
ii) Students, who have got admission in a recognized college to pursue technical/professional courses, without
facing any competitive examination, will also be eligible for scholarship. However, such student should have
less than 50% marks at higher secondary/graduation level. Selection of these students will be done security of
merit.
iii) For renewal cases - continuation of the scholarship in subsequent years will depend on successful completion
of the course during the preceding year.
iv) A scholarship holder under this scheme will not avail any other scholarship/stipend for pursuing the course.
v) The annual family income of the beneficiary/parent or guardian of the beneficiary should not exceed Rs. 2.50
lakh per annum from all sources.
vi) A student residing in a particular State/UT will be entitled for scholarship under the quota of that State/UT only
irrespective of this place of study.
vi) A student residing in Rajasthan state and studying in other state will submitted their application to District
officer Social Justice & Empowerment Department of his home district.
vii) For the list of listed 70 Institutions (for full fee reimbursement) please log on http//sje. rajasthan.gov.in
How to apply

1. Application in the prescribed format may be submitted to the Deputy Director/Asst.Director/District Probation
and Social welfare officer concerned District through the institutions where the students are pursuing technical/
professional courses. The student must submit their applications to the state which he/she belongs to and not to
the state where the institution where he/she is studying, is located.
2. Students should submit there application in there educational Institution. The educational institutes should
submit then all application forms with forwarding letter and consolidated list to concern District officer of
Social Justice and Empowerment Department.

Annexure-2
Draft format for
DECLARATION OF FAMILY INCOME

I................................................................................................(Father/Mother/Guardian) ----------------------------------- of
..................................................................................................(Name of Student) who is studying in
...........................................................................................hereby declare that my annual income from all sources is
Rs................................................................................................../- inwards ---------------------------------------

if at any stage, it is found that the information given by me is false/not true, all benefits given to the student under the
scheme of" Merit cum means bases scholarship to the student belonging to minority communities" could be with drawn
and legal action as deemed fit, may be taken against me or may ward.

Signature
Date:
(Father/Mother/Guardian) Residential Address

[This is a draft format which the State government/UT administration may modify/amend to suit legal requirements]

5
 Annexure-3
SCHEME OF MERIT CUM MEANS BASED SCHOLARSHIPS FOR STUDENTS BELONGING TO THE MINORITY COMMUNITIES
The list of such courses for which scholarships could be sanctioned under this scheme are as follows:-

S.no Stream S.no Courses

(A) Engineering & Technology Courses 1 Aeronautical Engineering (AE)
2 Agricultural Engineering (AG)
(B.tech/B.E./M.Tech) 3 Automobile Engineering (AUE)
4 Applied Electronics & Instrumentation (AEI)
5 Automation and Robotics (ARE)
6 Bio-Medical Engineering (BME)
7 Bio-Technology (BT)
8 Ceramic Engineering/Technology (CT)
9 Chemical Engineering (CH)
10 Civil Engineering (CE)
11 Computer Science and Engineering (CS)
12 Electrical Engineering or Electrical & Electronics Engineering (EEE)
13 Electronic and Communication Engineering (ECE)
14 Environmental Engineering (ENE)
15 Food Technology (FT)
16 Industrial Engineering and Management (IEM)
17 Information Technology (IT)
18 Instrumentation and Control Engineering (ICE)
19 Leather Technology (LT)
20 Marine Engineering (MRE)
21 Materials Science & Technology(MST)
22 Metallurgical Engineering (MT)
23 Mechanical Engineering (ME)
24 Mining Engineering (MN)
25 Oil & Paint Technology (OPT)
26 Polymer Science and Rubber Technology (PSR)
27 Printing Technology (PT)
28 Production Engineering (PE)
29 Pulp & Paper Technology (PPT)
30 Sugar Technology (ST)
31 Textile Engineering/Technology (TXT)
32 Transportation Engineering (TE)
(B) Cement Technology 1 Post graduate diploma in cement technology
(C) Fashion Technology (Degree from 1 B.FTech (Design): Fashion Design, Leather Design, Accessory Design,
Textile Design, Knitwear Design, Fashion Communication.
National Institute of Fashion 2 B.FTech (Apparel production)
Technology) 3 Me.FTech: Management, Apparel Production Design Space.
(D) Management 1 Post Graduate Diploma in Management (PGDM)
2 Post Graduate Certificate in Management (PGCM)
3 Executive Post Graduate Diploma in management (Exee-PGDM)
4 Master in Business Administration (MBA)
(E) Pharmacy (PH) 1 B.Pharma
2 M.Pharma.
(F) Architecture & Town Planning 1 Architecture (AR)

(Under Graduate and Post 2 Interior Design (ID)

Graduate level courses only) 3 Building Construction Technology (BCT)
4 Planning (PL)
(G) Hotel Management & Catering 1 Hotel Management & Catering Technology (HMCT)

Technology (Under Graduate and

Post Graduate level courses only)
(H) Applied Arts & Crafts (under 1 Applied Arts & Product Design (APD)

Graduate and Post Graduate level 2 Fine Arts/Applied Arts/Fine &Applied Arts (FA/AA/FAA)
courses only) 3 Fashion & Apparel Design (FAD)
(I) MCA 1 Master in Computer Application (MCA)

(J) Design (Degree from National 1 Graduate diploma in design

Institute of Design, Ahamdabad) 2 Post graduate diploma Programme in design

(K) Medical & Para Medical courses 1 MBBS
2 Bachelor of Ayurvedic Medicine & Surgery (BAMS)
3 Bachelor of Unani Medicine & Surgery (BUMS)
4 Bachelor of Homeopathic Medicine & Surgery
5 Post Graduate courses
6 Bachelor of Physical Therapy (BPT)
7 Master of Physical Therapy (MPT)
8 Bachelor of Occupational therapy (BOT)
9 Master of occupational Therapy (MOT)
10 B.Sc Nursing
11 M.Sc Nursing
12 BDS
13 MDS
(L) Veterinary Sciences and Animal 1 B.VSc. & A.H. (Bachelor of Veterinary Sciences and Animal
Husbandry)
Husbandry 2 PG courses

(M) Chartered Accountancy/Institute of 1 CA (Chartered Accountancy)

2 ICWA (Institute of Cost and Work Accountancy)
Cost and Work 3 CS (Company Secretary)
Accountancy/Company Secretary
(N) Law 1 L.L.B.
2 L.L.M.