to Download - Ntpc

APPLICATION FORMAT FOR NTPC SC/ST / PHYSICALLY CHALLENGEDSCHOLARSHIP SCHEME- XXIIITo :The AGM (HR-W )NTPC Ltd., NTPC BhawanSCOPE Complex, Core-.7,7 Institutional Area,Lodi Road,New Delhi – 110 003Self attestedColour photographName________________________________________________________Father’s Name __________________________Address for communication ________________________________________________________________________________________State_________PIN______________ Tel/Mobile No____________E-mail ID________________________Permanent Address ________________________________________________________________________State________________ PIN___________________Tel/. __________________ Mobile No.______________________Date of Birth D D M M Y YCategory:(A certificate from the Competent Authorityto this effect shall be enclosed) *SC ST OH VH HHDegree of Disability in respect of PC %(A certificate from the Competent Authorityto this effect shall be enclosed)(Seal/Sign of the Institute )Contd./pg2C:\DOCUME~1\ADMINI~1\LOCALS~1\Temp\Website Text.doc

-2-Qualification (Attach attested copies of mark sheets of all examinations given below)Name of Course Name ofInstitute1 st Year B.E./B.Tech2 nd year B.E./B.TechUniv./BoardBranchof StudyPassing Details ** ***D D M M Y Y % of marks1 21 3* OH – Orthopaedically handicapped, VH – Visually handicapped, HH – Hearinghandicapped** DD-Date, MM-Month, YY-Year*** In case of grades, mention equivalent % of marksI hereby declare that :I belong to SC/ST Community / I am a Physically Challenged student and I wish to beconsidered for NTPC Scholarship for SC/ST/Physically Challenged Students pursuingfull time four years degree in Engineering . My college/ university/ institute isrecognized by the Govt. of India.I am receiving scholarship / financial aid / stipend forpursuing my 4 years Engg. degree course.YNIf yes, Name of the Scholarship _____________________________________I have read and understood the various provisions, conditions and liabilities of NTPCScholarship Scheme and agree to abide by the same.I understand that if any information is found false/incorrect, it will disqualify me fromNTPC Scholarship apart from refund of the amount received by me.Date ___________________Place __________________Signature of the CandidateName ________________Mobile No:_____________(Seal/Signed by Authorised signatory of the Institute)C:\DOCUME~1\ADMINI~1\LOCALS~1\Temp\Website Text.doc

TO BE FILLED BY THE INSTITUTENote : Each Institute can sponsor a maximum of five students only for SC/STScholarship and two candidates for scholarship for physically challenged students.1. Certified that Sh./Ms. __________________________________ is pursuing fulltime 4 year Degree course in Engineering in the stream of Mechanical, Electrical,Instrumentation, Computer Science, Electronics/Telecommunication disciplineand is presently completed II year in (academic year 2012-13) of the course.2 The candidates whose application is being forwarded, started his/her 2 (Second)year session from ( month)___________(Year)2012 (mention the Month ).3 The student is receiving scholarship / financial aid / stipend from__________________________/not receiving any scholarship/financialaid/stipend from any other source as per records of the Institution #.4 The information furnished above by the student is in order and correct as perrecords of the Institution.General conduct of the student is satisfactory / unsatisfactory. ## Please strike out whichever is not applicableDate ____________Place:_____________Signature & SealHead of Institution/CollageName & Designation_____________________Full Address of Institution_____________________________________________________________________C:\DOCUME~1\ADMINI~1\LOCALS~1\Temp\Website Text.doc