VIDYA NIDHI

PRELIMINARY INFORMATION FORM FOR LOAN SCHOLARSHIP

(For Loan Scholarship for Students in India)

Personal Information

a) Name:

b) Date of Birth: c) Age:

d) Male / Female:

e) Nationality:

f) Caste: g) Sub-Caste:

h) Religion:

i) Fathers Name:

j) Yearly Income Rs. :

h) Permanent Residential Address :

k) Present Postal Address :

l) E-mail Id :

j) Family Details :

Name of the Family Members Relationship with Applicants Age Vocation

Details of Program for which Loan Scholarship is requested


a) Name of the Institution :


b) University / Board Affiliation :


c) Degree Course admitted to :


d) Duration of the Course : Years: Dates from : to

e) Total Loan Scholarship Requested:


f) Details of Loan Scholarship previously received from this Trust (from Vidya Nidhi scheme) :

Year Amount (Rs.)

References


a) The candidate is required to give two references of reputed persons other than his / her relatives who are in a position to testify from their personal knowledge as to the candidate deserving the scholarship applied for:

1. Name is full :

Occupation : Status

Full Residential Address :

Email Id : Phone No. :

2. Name in full :

Occupation: Status:

Full Residential Address :

Email Id: Phone No.:

Declaration by the Applicant


1. I, solemnly declare that the above information furnished by me is true and correct in all respect. Should any part of it be found otherwise, I understand that the Anandashram Sanstha is entitled in taking suitable action against me.

I have gone through the rules and conditions of the Vidya Nidhi of Anandashram Sanstha in connection with the award of a loan scholarship. I solemnly agree to abide by them.

2. I agree that merely submission of preliminary information form does not make me eligible for the next stage of Loan Scholarship and I will abide by the decision of the respective Scholarship Scrutiny Committee, on it.


Signature of the Applicant Name : Mobile / Contact No. : Place : Date :
_______________________________________________________________________________________________________________
For Office Use Only

Candidate may be asked to Submit Loan Scholarship Application.

Sign : ………...............................

Name :

Member Scholarship Scrutiny Committee
PLEASE SEND THE COMPLETED FORM TO :

By Post or Courier : Vidya Nidhi Team Anandashram Sanstha 22, Budhwar Peth Pune 411002

By email : anandashram.vidyanidhi@gmail.com or anandashramsan@gmail.com

Complete the form on our web site www.aanandashram-sanstha.org