Name:

Roll No:

Mobile No:

Personal Email ID:

Department:

Year of Joining:

Hostel:

Semester Applying For:

Category:GENOBCSC ST EWS

Parental income is less than 1 lakh?:YESNO

PwD:YESNO

Are you getting any other scholarships?YESNO

If yes, Scholarship Name:

Proof Enclosed:YESNO

Any Disciplinary Action History :YESNO

CGPA :

Do you have any siblings :

Advisor approval :YESNO

HOD Approval :YESNO

I agree to return the laptop after 4 years.

I agree to the terms & conditions as informed by the Dost office.