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Application Forms

The document is an application form for educational assistance from the Menda Foundation. It collects personal details of the applicant such as name, address, family details, academic qualifications and performance, details of the course or activity for which assistance is sought, and documents required to support the application. The applicant is also required to acknowledge returning the sanctioned amount once employed.

Uploaded by

adisontakke7777
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
16 views

Application Forms

The document is an application form for educational assistance from the Menda Foundation. It collects personal details of the applicant such as name, address, family details, academic qualifications and performance, details of the course or activity for which assistance is sought, and documents required to support the application. The applicant is also required to acknowledge returning the sanctioned amount once employed.

Uploaded by

adisontakke7777
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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MENDA

FOUNDATION
FDUCATIONAL ASSISTANCE APPLICATION FORM Date: _J_J___
SECflON I PFRSONAI. DETAILS OF BENEFICIARY

First Name:_________________________ Middle Name:_________________________


Last Name:______________________ Date of Birth: __J_ J~__ Age: ____

Gender: (Mark applicable) MaIeIEEJ Female fl Residence: Owned FEEl Rental C Stick a recent passport
Address: _________________________________________________________________ size picture

City/Town: _________________Dist. _______________ State: __________________________

Pin Code: __________Home #. _______________ Mobile if____________________


Email________________________________________________________________________________
Class/Course: _____________________ Institution/School Name:__________________________________________________
SECTION 1 A FAMILY DETAILS
Relation Name Qualification Occupation Monthly Earnings
Father
Mother
Brother
Brother
Sister
Sister
SECTION 1 B ACADEMIC DETAILS
Name of Course/Activity Institution/school Name Mark % &/or
Achievement
1. 10th —Standard

3. First Year
4. Second Year

5. Third Year
6. Extra Curricular
7. Sports
SECTION 2 APPEAL

Total Fee/Year: ~ ____________ Fee Paid: Yes El No FEEl


Source of Funds: __________ assistance required: ~_____________ Cheque favouring:___________________________
Are you getting assistance from any other source Yes EEl No ~ If yes, details_______________________________________

Any other Information:

PTO
REFERENCE: Give reference of two prominent persons in your locality (Your teacher/Professor/Doctor etc.)
Name Address Profession Contact No.

SECTION 3 DOCUMENTS

LIST OF DOCUMENTS (Mark Applicable) 1. Break up of F-ees/Letter from School L...J 2. Past two years’ marks cards U
3. Fee Receipt EEl 4. Family Income Proof fl

SECTION 4 ACKNOWLEDGEMENT AND DECLARATION

ACKNOWLEDGEMENT
In order to help other eligible students, do you agree to pay back the Scholarship amount sanctioned to you by Menda Foundation? If
yes, please sign below. By doing so you acknowledge the fact that you will return the sanctioned money back to the Foundation once
you are gainfully employed.

Date:_J._./_______ Signature

DECLARATION
I hereby certify and confirm that the above mentioned details and support documents are true, genuine to the best of my knowledge
and that there is no discrepancy.

Date: _/__J______ Signature

SECTION 5 FOR OFFICE USE


For Office Use only

Recommended for Sanction ~ Not Recommended for Sanction C

Remarks:________________________________________________________________

Amount Recommended for Sanction: t__________________________

Recommended by Sanctioned by Disbursed by


(Signatory) (Signatory) (Signatory)

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