GOVERNMENT OF SIKKIM

OFFICE OF THE WELFARE OFFICER ( N/S/E/W )

SOCIAL JUSTICE, EMPOWERMENT AND WELFARE DEPARTMENT

GANGTOK

APPLICATION FORM FOR PRE/POST – MATRIC SCHOLARSHIP

1. Name of the applicant ( in block letters ):- ……. …………………………

2. Father’s name :- ………………………………..

3. Occupation of the father / guardian :- ………………………………..

( designation if in Govt. service ) ………………………………..

4. Name of the school with address :- ……………………………….

5. Total Annual Income of parents :- ………………………………..

6. Permanent Address :- ………………………………..

Telephone no:- ……………………………….

7. Present Address :- ……………………………….

……………………………….

Telephone no :- ……………………………….

8. Class for which scholarship applied for …………………………

(Year )………………………………

9. If handicapped, please give details:- ……………………………….

Signature of the Parent / Guardian

Full Name :- ………………………

Date :- ……………………….

Certified that the information given above are verified and found to be correct.

Signature & Seal of H.M. / Principal

Date :- ……………………

Telephone no :- ……………………

Required Documents :-

Attested copy of :-

i) Sikkim subject / Domicile Certificate / BPL card

ii) ST/SC/OBC Certificate

iii) Income certificate of parents, if in Govt. Service salary certificate from the HOD

iv) Copy of mark sheet of the last examination passed by the students

NOTE:-

1. Grant of scholarship is subject to eligibility and terms and condition as laid down in the guidelines.
2. The last date of submission of the application is -----------------------
3. Incomplete application form and those submitted after the last date shall not be entertained.