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

org

Education for Individual Student Information Form 4.0

PERSONAL DETAILS 1. Full Name (Block Letters) : 2. Permanent Address:

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

Pin code : 4. E-mail ID (if any): 5. How do you know about India Sudar?

phone no:

FAMILY DETAILS Relation 6. Father 7. Mother 8. Brothers and Sisters 1 2 3 4

Full Name

Age

Occupation/ Education

Income per month/ place of study

Comments/ additional information if any:

Education for Individual Student Information Form 4.0

PAST EDUCATION DETAILS (Fill whichever applicable) 9. Class Name of School/College SSLC +2 Any other if any
*( G- Government GA- Government Aided P- Private)

*Category G/GA/P

Year

% Marks

CURRENT EDUCATION DETAILS 10.Name of the course 12. Institution Name & Address

11. Year of Admission 13. *Category G/GA/P 14. Duration of the course 15.Percentage/Mark s obtained till date

Pincode: 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

Inst. Ph:

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?

22. Have you tried for Education loan?

(If No, specify the reason)

Education for Individual Student Information Form 4.0

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

PER YEAR

PARTICULAR g. Contribution From Parents

PER YEAR

h. BC/MBC/SC/ST/PH scholarship or any other scholarship if any b. Book Fee (If You do not know , please get the details from College office/ seniors) i. Education loan j. Stipend from other organization/well wisher

c. Uniform Fee d. Hostel Fee ( Room rent, Electricity, Water charges, deposits etc) e. Mess Fee per year (approx) f. Other fee if any P. TOTAL ( a to f) 23 . PENDING (P-Q)

Q. TOTAL (g to j)

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.

Signature of the Applicant

Date:

Education for Individual Student Information Form 4.0

For office use only: Requested Organization: Name of the Indiasudar Work Coordinator with Member code:

Date:

Education for Individual Student Information Form 4.0