Application for Ottur Scholarship 2011-2012 (Kindly read the instructions in page 2, before filling-up this form)
Name: Address: Pincode: Father’s name: Office address: Pincode: Mother’s name: Office address: Pincode: Illam name:
Date of birth:
Telephone:
Sex: M / F
e-mail: Job:
Telephone: Job: Telephone: Address:
Telephone:
Vedam: Rigvedam / Yajurvedam / Saamavedam Gothram & Pravaram: Sub-sect: Kaushitakan / Aaswalaayanan (Pakazhiyan) / Boudhaayanan / Baadhoolakan / Jaimineeyan Ammaath name: Address: Telephone: Course Name Institution Year % Marks & Rank SSLC +2 Rank in Entrance exam: Year of Appearance: Present course name: Seat: Merit / Self Financing Branch: Semester: College: University: % Marks: S1: S2: S3: S4: S5: S6: S7: S8: (S1 indicates 1st Semester. In case of year, replace S1, S2, … by Y1, Y2, …)
Do you receive any other scholarship ?: Y/N If yes, give details below Scholarship Name Amount per year 1. 2. Total college fees per year: Total hostel fees per year: Other track records (Attach supporting documents, if any): 1. 2. Name of brother(s) / sister(s) Age Qualification Job 1. 2. 3. Total annual family income: Place & date: I hereby undertake that I am studying in Government / Government Aided professional college and the above given details are fully correct. I am aware of the possibility of rejection of my candidature, in case of any mis-information or hidden-information from my side. Moreover, I hereby undertake that I, all my parents as well as grandparents belong to Namboothiri community.
Signature (Parent/Guardian)
Signature (Candidate)
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Instructions to the candidate applying for Ottur Scholarship-2011-2012 • • • •
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Ottur Scholarships are offered only to financially poor Namboothiri boys/girls, having their total annual family income less than Rs. One lakh and fifty thousand. This year, we offer two scholarships. Each scholarship, worth Rs. 10,000 per year (Rupees ten thousand only), is offered to a candidate pursuing MBBS / BDS / BVSc / B. Tech stream. You are eligible for this scholarship only if your parents do belong to Namboothiri community. Only candidates from government (or government aided) engineering / medical / dental / veterinary colleges are eligible. Candidates from self-financing colleges are not eligible to apply. You may use the photostat copy ( or computer print out ) of the application form. In case any cell-space in the application form is inadequate, you may use additional sheets. In such case, kindly mention, “See additional sheet” in the respective cell. Kindly produce the attested photostat copies of the following documents, along with the application, exactly as mentioned. 1. Your SSLC and +2 mark lists as proof for the marks obtained so far. 2. First page of your SSLC book as the proof of family background. 3. A certificate from the respective authority to show that the total annual income of the family (including father’s, mother’s and brothers’ revenue from agriculture, business, and the salary) is less than Rs. One lakh and fifty thousand. 4. Salary certificate of father and mother, if they are employed. 5. A letter from the head of the college stating the course studying, commencing year, year of study, details of other scholarships which you receive etc. The signatory of this letter should also undertake that you have not failed in any internal as well as external examinations conducted so far by the college as well as the university, as part of the course. 6. An introductory letter from a respectable, well-known Namboothiri (male/female) in your vicinity. (His telephone number as well as full address are mandatory) 7. A certificate from the medical authority, if you are physically handicapped. If remain eligible, those who have received this scholarship last year may apply this year too. The selection would be based on the candidate’s merit, financial background, extra curricular activities, vedic skills etc. Kindly send the application to P. Vinod Bhattathiripad, Polpaya Mana, Thiruthiyad, Calicut-673 004, Kerala. Telephone: 0495-2720522 (R), 94470-60066 (M). Email: vinod@namboothiri.com. Last date of the receipt of application is 25/03/2012. The decision of the selection committee will be final and binding. The Ottur Scholarship is a project of an NRI engineer of Ottur Mana, (originally at Mayannur, Thrissur district).
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