SCHOLARSHIP APPLICATION FORM
Instructions:
I. Eligibility Criteria for the first academic year:
a. Applicants must come from an economically disadvantaged background, with a family Income
not exceeding 8 lakhs per annum.
b. For B.Sc. Nursing or B.Sc. Allied Health Sciences Students:
Applicants must have been admitted to the I year B.Sc. Nursing or B.Sc. Allied Health
Sciences at Shri Dharmasthala Manjunatheshwara University.
The applicants must have scored a minimum of 50% in Physics, Chemistry and Biology
(PCB) in their last qualifying examination.
c. For GNM Students:
Applicants must have been admitted to the 1st year GNM at SDM institute of Nursing
Sciences Dharwad.
GNM applicants must have scored a minimum of 50% in 10+2 Examination
(Science/Arts/Commerce) streams.
II. Eligibility Criteria for the subsequent academic years:
Scholarship in the subsequent academic years, if any, is subject to submission of fresh
application by such of those students who have availed the benefit of scholarship in the
preceding academic year and have completed the course with marks not less than 50% that
too at first attempt, without any changes in their economic status, wherever applicable.
III. Submit this form along with the required documents to Office of the Registrar Shri
Dharmasthala Manjunatheshwara University, 6th Floor Manjushree Building Dharwad by
_________. Incomplete or late applications will not be considered.
Scholarship Name: Vidya Vikasa Nidhi Student Scholarship
Course Name: ____________________________________________________________________
Personal Information:
Full Name: ________________________________________________________________________
Father Name: _______________________ Mother Name: ______________________________
Date of Birth __________________________ Gender: ___________________________________
Contact Number: ______________________ Email: ____________________________________
Permanent Address: ______________________________________________________________
City: ___________________________________ State: _____________________________________
PIN Code: ________________
Educational Details:
Course Applied For: ______________________________________________________________
Course Duration: ________________________ Intake Year: ___________________________
Name of the Institution: __________________________________________________________
Previous Educational Institution: _________________________________________________
Previous Years’s Marks: _____________________ Percentage: _______________________
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Financial Information:
Annual Family Income: __________________________________________________________
Are you currently receiving any external financial aid? [ ] Yes [ ] No
If yes, please specify the source and amount: ___________________________________
__________________________________________________________________________________
Declaration:
I hereby declare that the information provided in this application is accurate and true to the best
of my knowledge. I understand that any false information may result in the disqualification of my
application. I also acknowledge that if I am selected for this scholarship and subsequently opt
for any other external financial aid, the [ Scholarship Name] will be discontinued.
Attach the following supporting documents with the application form:
Copy of the admission letter from the SDM University/SDM institute of Nursing Sciences.
Copy of the latest mark sheets
Income certificate or any valid document providing proof of family income (less than 8
lakhs per annum)
Signature: _________________________________________ Date: _______________________
Parent / Guardian Signature (if applicable):______________________________________
Signature of the HOI: ___________________________________
…………………………………………………………………….
For Office Use Only
Application Number: ____________________
Application Status: [ ] Received [ ] Verified [ ] Shortlisted [ ] Rejected
Signature and Seal
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