Download - Department of Higher Education

.......................... for the class in which Student studying ................ and session..................
from the Directorate of Higher Education, H.P. Shimla-1.
Counter Signature of Principal / Head of Institution
With seal
Signature of Student
Note: - One student is entitled to receive only one scholarship (which is on the higher side) in a
particular session until and unless it is otherwise mentioned in the norms of a particular scheme
Application Form For Protsahan Chhatravriti Yojana
Name of the Scheme Protsahan Chhatravriti Yojana ………Year…………………
1) Name of the student(in capital letters)…………………………………………………………
2) Date of Birth …………………………………………………………………………………
3) Sex (Male/Female)…………………………………………………...
4) Father’s Name (Sh.).…………………………Mother’s Name (Smt.…)…………..………….
5) Permanent Home Address. …………………………………………………………………….
…………………………………………………………………………………………………..
Telephone/Mobile No.………………………………………………………………………….
6) Class in which admitted……………………Date of Admission……………………………….
7) Name of the Institution in which admitted ……………………………………………………
8) Anticipated percentage of month wise attendance till the end of session (month wise 80% and
above attendance is compulsory for this Scheme & attendance to be duly verified by the class
teacher)……………………………………………………………………………………………
………………………………………………………….……………………………………
9) Actual distance from Permanent Home ………………………………………………………
10) Admissible Amount month wise………………………………………………………………
11) Total Refundable amount (i.e Claim)…………………………………………………………