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MINORITY WELFARE POST MATRIC SCHOLARSHIP SYSTEMRenewalSTUDENT

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MINORITY WELFARE POST MATRIC SCHOLARSHIP SYSTEMRenewalSTUDENT
MINORITY WELFARE - POST MATRIC SCHOLARSHIP SYSTEM

Renewal

STUDENT APPLICATION

For official use only
Sl No of application

Year

Course

Student ID: T2012kapms070282

Whether approved

Affix a self attested passport size photograph

Roll No: 607

1.Student name

:

IMAN SHAHAB

2.Father's name/Husband's name

: Mohammed Ismail

3.Mother's name

: JAHARA

4.Mobile No
5.E-Mail ID

aimanshah18@gmail.com

6. Domicile State/UT (State/UT which the student belongs to)

:

Karnataka

7. Address for correspondence:
House No. & Street Detail

D/o Mohammed Ismail, Bahar Manzil

City/Town/ Village & P.O.

60 feet road nehru Nagar

District

CHICKMAGALUR

State

Karnataka

Pincode

577101

8. Permanent address(please enclose residential certificate from concerned state government authority):
House No. & Street Detail D/o Mohamme dIsmail Bahar Manzil
City/Town/ Village & P.O. 60 feet road nehru Nagar
District

CHICKMAGALUR

State

Karnataka

Pincode

577101

9. Date of birth (Please enclose certificate) :

16-Aug-1992

10. Whether male or female

:

Female

11. Religion

:

Muslim

12. Nationality

Printed Date: 25-Oct-12

:

Indian

Page 1 of 7

13. Details of educational qualifications from matriculation/SSLC/SSC onwards (Please enclose certificates attested by a gazetted officer):
Examination University/Board/Institution/Council of passed Examination
Main
Subjects

Year of
Passing

Division
Percenta
/Class/ ge marks
Grade

14. Details of course for which scholarship is being sought:
Name of the technical/professional course: BCA( Batchlor of Computer App )
Duration of course

3

Academic year

2012-2013

Hosteller

N

15. Basis of admission in professional/technical course (whether on the basis of qualifying competitive examination or on other grounds. Please give details):

16. Details of college/institution:
(i) Name of the college/institution where admitted:

MOUNTAIN VIEW COLLEGE MANAGEMENT SCIENCEVIDYANAGAR

(ii) Address of college/institution:

(iii) Telephone no:
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