∗ Please read the Application Manual for Scholarship before filling up the form.

DITO MERIT SCHOLARSHIPS APPLICATION FORM

For Higher Secondary / CBSE + / ISC Passed students

Note:

• Each item should be read carefully before filling the form. No change will be permitted after it has been submitted. If any entry is found to be incorrect, the scholarship, if awarded, is liable to be cancelled forthwith.
• IncompIete Applicafions or Applicafions after the prescribed date will not be considered.
• EIigibiIity criteria of marks: For Class XII passed out students 70% in aggregate ( best of 5 subjects).
• EIigibiIity criteria of Family Income: less than El 5000 per month.
• SchoIarships will be given to meritorious girl students only.
• SchoIarships will also be given to physically challenged students.
• Girl Students from schools located in West Bengal are only eligible to apply.
• AppIications of Class- XII passed and college students to be submitted.
• The final selection of DITO Scholars will be the sole discretion of the Board Members of DITO Foundation.

Name Of The Student: (IN BLOCK LETTERS) (As per Class XII Admit Card)

Date of Birth : (DD-MM-YYYY)

Sex :

• Male
• Female

PhysicaIly Challenged :

• Yes
• No

Mention percentage of disability :

Browse

Permanent Home Address:

Post office:

Police Station:

District:

Pin:

Address of correspondence:

Post office:

Police Station:

District:

Pin:

Telephone Number with STD Code:

Mobile Number:

E-mail ID:

Details of Father / Guardian:

Name:

Address:

District:

Pin:

Occupation:

• Salaried
• Daily
• Wage Earner
• Agriculture
• Others

Telephone Number:

Whether Father / Guardian is the citizen of lndia:

• Yes
• No

Income Details:

Type of Residence:

• Own / Rented
• Pucca / Katccha

Does your family posses land:

• Yes
• No

If Yes mention type and area of land:

Does your family posses Television:

• Yes
• No

Do you have access to safe drinking water:

• Yes
• No

Do you have a disabled member in the family:

• Yes
• No

Is your family BPL/ Antyodaya card holder:

• Yes
• No

Total monthly income of: Father

Total monthly income of: Mother

Total monthly income of: Other Family Member

Number of Family Members

Number of Earning Members

Particulars of School / Institution last attended :

Name of School / Institution:

Address of School / Institution:

Pin:

Nearest Railway Station:

Affiliation:

• WBSHCE
• CISCE
• Others

Telephone Number of School with STD Code:

Details of Class XII Examination passed by the student :

Name of the Examination passed:

• Higher Secondary
• CBSE
• ISC
• Others

Roll number:

Year of passing:

Percentage of Marks obtained in aggregate:

For Class XII :

Subject

Marks Obtained

Grade

Total

Any significant achievements made

Mandatory Field

Passport Size Self Attested Photo of The Student
(3.5cm X 3.5cm)

Submit