INDIA SUDAR EDUCATIONAL AND CHARITABLE TRUSTRegistered No: 454/2004 web: www.indiasudar.org mail: admin@indiasudar.org

Education for Individual – Student Information Form 4.0

PERSONAL DETAILS1. Full Name (Block Letters) :

2. Permanent Address:

Pin code : phone no:3. Postal Address : (if it differs from permanent address)

Pin code : phone no:

4. E-mail ID (if any):

5. How do you know about India Sudar?

FAMILY DETAILSRelation Full Name Ag

eOccupation/ Education

Income per month/ place of study

6. Father

7. Mother

8. Brothers and Sisters

1

2

3

4

1 Education for Individual – Student Information Form 4.0

Comments/ additional information if any:

PAST EDUCATION DETAILS (Fill whichever applicable)9. Class Name of School/College *Catego

ryG/GA/P

Year % Marks

SSLC

+2

Any other if any

*( G- Government GA- Government Aided P- Private)

CURRENT EDUCATION DETAILS10.Name of the course

11. Year of Admission

12. Institution Name & Address

Pincode: Inst. Ph:

13. *CategoryG/GA/P14. Duration of the course

15.Percentage/Marks obtained till date

16. Last date to pay the fee

17. Mode of payment : DD / Cheque

(Indiasudar does not give cheque / DD in favour of student ‘s name. Please get the details from the school/college)18. Payable at

QUESTIONNAIRE ( All particulars will be verified. Application will be rejected if found wrong)

19. Do you have own house? (if Yes, approximated value of the house Rs._____________ Square feet _________ Type of house_____________ )

20. Do you have own land? if Yes, Square feet _______

21. Do you want to return this money (without interest) after joining any job?

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22. Have you tried for Education loan? (If No, specify the reason)

FEE PARTICULARS AND REQUIREMENT PER YEAR

Note: Please provide the real information and data. All the fee details should be entered per year and NOT on per semester

basis. Cross verification will be done at any point of time either through college or

other ways

PARTICULAR PER YEAR PARTICULAR PER YEAR

a. Tuition Fee (Add all the semester /school fee and mention the FEE per YEAR)

g. Contribution From Parents

b. Book Fee

h. BC/MBC/SC/ST/PH scholarship or any other scholarship if any

(If You do not know , please get the details from College office/ seniors)

c. Uniform Fee i. Education loan

d. Hostel Fee( Room rent, Electricity,Water charges, deposits etc)

j. Stipend from other organization/well wisher

e. Mess Fee per year (approx)

f. Other fee if any

P. TOTAL ( a to f) Q. TOTAL (g to j)

23 . PENDING (P-Q)

I hereby declare that all statements contained in this application are true and correct and understand that false or inaccurate information in the application will be the basis for cancellation.

3 Education for Individual – Student Information Form 4.0

Signature of the Applicant Date:

For office use only: Requested Organization: Date:

Name of the Indiasudar Work Coordinator with Member code:

4 Education for Individual – Student Information Form 4.0