Mukti

Name of the Applicant*

Gender*

Male

Female

Cast Name*

Religion Name*

Date of Birth*

Email*

Recent color passport size photograph of applicant (Non-attested)* Choose different image

Father's Name*

Father's Occupation*

Mother's Name*

Mother's Occupation*

Parents Contact Number*

Student's Contact Number*

WhatsApp Number*

Aadhar Number*

Aadhar Proof Image*

Permanent Address*

Location*

Landmark*

District*

State*

Pin/Zip*

Present address*

Present address is same as parmanent address

Location*

Landmark*

District*

State*

Pin/Zip*

Including you number of family members*

Describe the family members type*

Total duration in Years *

Current year being Pursued *

Institution Name *

Institution Address *

Institution District*

Institution State*

Institution Pin/Zip*

Entrance Test Name (If Applicable)

Rank (If Applicable)

Year Appeared

Year of admission of current class*

Year of course completion (Must mention month & year)*

Admission fees of Institution per year in Rupees *

Expenses on books per year in Rupees *

Hostel (If Applicable ) expenses per year in Rupees

Private tuition expenses per year in Rupees

Total expenses (Including all) per year in Rupees *

Proof of admission to the course and the tuition fees paid/payable per annum duly certified by the institution authority (Upload image jpg, jpeg, png file is maximum acceptable 1mb).

Total annual income of family from all sources *

Income of parents certified by any person mentioned in the brackets. (Gram Pradhan, Councilor, M.L.A, M.P, Member of Zila Parishad, B.D.O. or any Govt. Officer).

If the applicant received any stipend/scholarship/ any other Govt. scheme. If yes, please specify with name, nature of scholarship and amount in Rs annually.

Institution Name *

Institution Address *

Board *

Year of Passing *

Percentage (%) of Marks *

Scan image of Madhyamik / 10th standard marksheet *

Higher Secondary /12th standard Details

Institution Name *

Institution Address *

Board *

Year of Passing *

Percentage (%) of Marks *

Scan image of Higher Secondary / 12th standard marksheet *

Bachelor / Diploma Degree Details

Institution Name

Institution Address

Board

Stream

Specilization/Honours

Year of Passing

Percentage (%) of Marks

Scan image of bachelor degree marksheet

Bank Name *

Account Holder's relationship with applicant

Upload front page of your bank account passbook or cancelled cheque book page, where account details are mentioned. If you don't have personal bank account then share your family (Parents) account information. Choose different image

With my best knowledge the above bank details are correct and verified.

DECLARATION BY THE APPLICANT *

I do hereby declare that all the above information furnished by me is true. In case, any discrepancy is noticed, MUKTI has every right to terminate my sponsorship. I declare that my character and behavior will be exemplary and I shall maintain high scholastic standards and values, thereby setting an example for otherupees I will inform MUKTI of all changes in the course of my sponsorship and course ending period. I will also attend any kind of seminar/ annual programme/ meeting/workshop as will be informed to me. Failing to do so will result in cancellation of my sponsorship. I want to do social work activities as well as my study. I also give my consent to Mukti to share and release my credentials in forms of audios, videos and photos in social media for fundraising towards social cause.

Agree

Disagree

Responsibilities of a scholarship holder:

You are requested to inform Mukti in case of a change in contact number or address.
In case of discontinuation of your study or change in course, you need to inform Mukti.
You need to invest a mandatory 100 hours of social work in a year as part of the Mukti Sathi initiative.
You need actively participate in Value Education and Health (Yoga) classes as part of Mukti.
You may be requested to be present for an in-person/virtual meeting with the sponsor when the sponsor wishes to meet.
You may be requested to record and send video or written messages to the sponsor/Mukti.
You need to be present in person or online as decided by Mukti, for meeting with the sponsor.
Sponsor can directly call you and request your well-being and study-related information and your information will be true and honest always.
In any circumstances you can't misbehave with your sponsor and any staff of Mukti.
We request you to come forward to help by guiding/motivating/sponsoring needy student/s after your establishment in your professional career.

Agree

Disagree

Area /Location of applicant (Locality) *

Referred/Recommended by (Where / who did you get the news of this scholarship?) *

Create your own profile (Minimum 100 words)*

Signature of the applicant*

Talented Students Sponsorship Application form for 2024-25

Applicant Details

Select for which stream scholarship is opted.

Current Course Details

Education Details

Madhyamik /10th standard Details

Higher Secondary /12th standard Details

Bachelor / Diploma Degree Details

Bank details of candidate: (SBI is Preferable)

Additional Details *

DECLARATION BY THE APPLICANT *

Responsibilities of a scholarship holder:

Talented Students Sponsorship Application form for 2024-25

Applicant Details

Select for which stream scholarship is opted.

Select stream and type your Specilization/Honours Subject.

Current Course Details

Education Details

Madhyamik /10th standard Details

Higher Secondary /12th standard Details

Bachelor / Diploma Degree Details

Bank details of candidate: (SBI is Preferable)

Additional Details *

DECLARATION BY THE APPLICANT *

Responsibilities of a scholarship holder: