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INDIAN SCHOOL OF MINES, DHANBADOFFICE OF DEAN (STUDENTS WELFARE)

No: DSW/08/ISM MCM/2011-12 Dated: 21.09.2011

N O T I C E

FOR FRESH AWARD OF MERIT CUM MEANS SCHOLARSHIP including

FREESHIP for 1st

Year B.Tech/Dual Degree & 2/3 years M.Sc/M.Sc.Tech and 1st

year MBA students for the Session 2011-12.

Applications in prescribed forms available from Office of Concerned Hostels

are invited for award of the scholarship so as to reach the office of the undersigned on

or before 31.10.2011, as per details below. LATE APPLICATION WILL NOT BEACCEPTED ON ANY GROUND.

ELIGIBIL I TY CRITERIA

The candidate must have secured 1st class or equivalent grades in I.Sc./10+2

examination for B.Tech, Dual Degree and in Graduation examination for 2/3 years

M.Sc./M.Sc.Tech & MBA.

Income of the Parents/Guardian should not be more than Rs. 2,00,000/- during

the financial year ending 31.03.2011. Application should be accompanied with

Photocopy of fee receipt, Marksheet of Previous exam and original income certificate

of Parents/Guardian of the applicant issued from the office of SDO

(Civil)/DM/DC/ADM/SDM/RDO with proper seal, in the prescribed format

available in Office of respective Hostel Warden as a proof of their income. Income

certificates from any other like MRO, Tahshildar, Sub Collector, Judicial Magistrate,

Upakhand Collector etc. WILL NOT BE ACCEPTED.

(Prof. S. Laik)

Dean (Students Welfare)

Cc : DT/RG

: DR(Acad & SW) /DR(Exam) /AR(Acad)

: DSW, CHWNotice Boards

: Opal Hostel/Diamond Hostel/Jasper Hostel/Ruby Hostel

: General Notice Board

: Web/ MD

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INDIAN SCHOOL OF MINES , DHANBAD

Office of Dean (Students Welfare)

Application for award of ISM Scholarship/Freeship for 1st

year B.Tech, Dual Degree, 2/3 Years

M.Sc./M.Sc.Tech and 1st

Year MBA (New Entrants) for the Academic Session 2011-12

1. Name of student(in capital letters)

2. Admission No.

3. Course & Year

4. Duration of Course (2yrs/3yrs/4yrs/ 5yrs)

5. IIT JEE Rank

(copy to be attached)

6. Percentage of Marks in I.Sc./10+2(copy to be attached)

7. Fathers /Guardians Name

8. Occupation/Profession of Father/Guardian

9. If salaried, employment details of

father/Guardian

10. Gross Annual Income of father/guardian

(attach income certificate)

11. Mothers Name (capital letters) &Occupation

12. If salaried, Employment details of mother

13. Gross Annual Income of mother

(attach income certificate)

14. Familys Gross Annual Income

15. Whether getting any other scholarship

16. S.B.I. Account No. of applicant

17 Contact Number (M)

NOTE: Income certificate, in original, issued from the office ofDM/DC/SDO(Civil)/ADM/SDM/RDO with proper

seal is to be attached. The application without the supporting income certificate, Marks sheet (Xerox copy) & Fee

receipt (photo copies) as above will be rejected. Incorrect information will entail disciplinary action. Income

Certificate from any other like MRO, Sub-Collector, Tahsildar, Judicial Magistrate, etc. will not be accepted.

I certify that the particulars furnished above are true and correct to the best of my knowledge and belief. I also

undertake to abide by the Rules & Regulations of the Scholarship awarded by ISM from time to time.

Enc: As above. Signature______________________

Date:_________________________

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