IRF Scholarship Form - SECAB

IRF UNITED ISLAMIC AIDManaged ByISLAMIC RESEARCH FOUNDATIONRegd. Public Trust No. B-1409 (Bom)Zohra Manzil, 195/213, SVP Road, Dongri, Mumbai 400 009 23736875 (8 lines) Fax 91-22-23730689 contact@irf.net www.irf.netIRF EDUCATIONAL SCHOLARSHIP (2012-13) APPLICATION FORMSr. No.:Date:To.Islamic Research FoundationZohra Manzil, 195/213, SVP Road,Dongri, Mumbai 400 009, India.PHOTOGRAPH(less than 3 months old)PARTICULARS1. Name of the Applicant:2. Sex: 3. Age: 4. Date of Birth: 5. Religion:6. Marital Status (tick one applicable): Married Single Divorced Widowed7. Present Address:Mobile: Tel: Email:8. Permanent Address:Tel:9. Parent/Guardian’s Name:10. Parent/Guardian’s Office Address:Mobile:Tel:11. Occupation (tick whichever applicable): Student Employed Self-employed Unemployed12. Monthly income of applicant (if any):13. Total monthly family income (from all sources):14. Approximate total monthly Family Expenditure:15. Duration of stay at Present Address: 16. Total No. of Family Members:17. Details of Family Members:Name Age Relationship Education Occupation Monthly IncomePage 1

ACADEMIC AND RELATED INFORMATION1. Name of School / College / Institution:2. Address of School / College / Institution:3. Study Course (Full Name):4. Degree Diploma Other 5. Duration of Course: 6. Branch:7. Year / Standard: 8. Division: 9. Roll No.: 10. Medium of Instruction:11. Subjects: (i) (ii) (iii)(iv) (v) (vi)12. Annual Fees: Rs.13. Rank in Last Annual Exam: out of 14. Total Marks: out of ( %)15. Prizes / Certificates received in School / College / Institution:16. Prizes / Certificates received in other Academic Competitions / Sports:17. Extracurricular Interests / Hobbies:18. Student’s Aspirations after completing the course:19. Any other information strongly supporting the request for Scholarship:20. Academic PerformanceExam School / College Year of Passing Percentage21. Details of Scholarship requested from I.R.F.:22. Details of Scholarship received / Awaited / Requested from other sources for current year:23. Details of any Scholarship received earlier from I.R.F. / other sources:24. Reference for Verifying the information given: (Name, Address & Contact Nos. of confirmable reliable sources):Mobile:Tel:Page 2