Scholarship Form 2

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TEZPUR UNIVERSITY

APPLICATION FOR SCHOLARSHIP


Sponsored by:
_________________________________________________________________
Sanction No & Date:
_________________________________________________________________
_________________________________________________________________
1. Name (in block letters) in full:
____________________________________________________
2. a) Programme of Studies:
____________________________________________________
b) Department: ____________________________________________________
c) Class Roll No: ___________________ d) Date of joining
________________
3. Period of claim: From _____________________ to
_______________________
4. Scholarship amount: Rs. ________________ (Rupees
_________________________
____________________________________________________
5. a) Are you receiving any other Scholarship during the above mentioned period?
Yes/No
If yes, please detail: ____________________________________________________
b) Which scholarship would you prefer to receive:
____________________________________

Date: Signature of the applicant


FORWARDING NOTE OF HEAD OF THE DEPARTMENT

The attendance of the student during the period was found satisfactory / not
satisfactory and recommended/ not recommended for release of scholarship.

Memo No: _______________________ Head, Department of


__________________________
Date: _______________________ (Seal)

OFFICE ORDER
Scholarship money Rs. ________________________ (Rupees
________________________________ _____________________________________________) be
paid.

Controller of
Examinations
Pre-receipt
Transfer the amount into my SBI A/C
No……………………………………………....
Received Rs. ________________________ (Rupees
_________________________________________ _______________________________________) in
full in cash / vide cheque no ________________ Date _________________ Signature
on
Revenue
Stamp

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