http://www.faeaindia.org/NewApps/Fill_application.asp 1/2
FoundationforAcademicExcellenceandAccess(FAEA)APPLICATIONFORMScholarship2015
Pleasefilluptherequiredinformation.*Fieldsmarkedwithasteriskaremandatory.
P e rs o na l D e t a i l s1.*
FullNameasitappearsinyourSSLC/SSCcertificate Mr.
1.b* Mother'sName 1.c* Father'sName
2.* CompletePermanentAddress(withHomeState&City): *
HomeState/U.T.
Select
* City/District
SelectCity
Ifothers,Specify
* PinCode2.* CurrentAddress(Addressfor
Communication)ClickheretorepeatPermanent
Address
* State/U.T. Select
* City/District
SelectCity
Ifothers,Specify
* PinCode
3.a* MobileNo.(10digitsonly) +91
3.bMobileNo.2/TelephoneNo.withSTDCode/
4. FaxNo.withSTDCode 5. EmailAddress
6.* Gender Select
7.* DateofBirth(DD/MM/YYYY) Day Month YearSo c ia l B a c k g ro
und
8.* Category Select 9. IfSC/ST/OBC,pleasespecify
10.* DoyoubelongtoBelowPovertyLine(BPL)Category? Select
11.*DoyouhaveBPLCard?Ifyes,givetheBPLCardNo.
Select
12.* DoyoubelongtoaReligiousMinority? Select 13.*
Doyouhaveaphysicalorsensorydisability?
Select
Ifyes,pleasespecify
14.*
WhowasthefirstpersontocompleteMatriculation(uptoclass10)inyourimmediatefamily
Select
15.a* Father'sEducationLevel Chooseone 15.b*
Mother'sEducationLevel Chooseone
Educationlevels Primary1stto5thor6th Middle7thto8thor9th
Matriculation10thPass SeniorSchool11thto12thPass
GraduationBA,BSc,orequivalent
PostGraduationMA,MSc,LLb,MBBSorequivalent/graduationintechnicalfield
DoctoralorhigherprofessionaldegreePhD,MPhil,LLM,MS,MDorequivalent
16.* Father'sOccupation 17.*Father'sIncome(Rs.perannum)
SelectFather'sIncome
18.* Mother'sOccupation 19.*Mother'sIncome(Rs.perannum)
SelectMother'sIncome
E duc a t i o na l B a c k g ro und
20.* ClassXIIthSchoolName/InstituteNameDiploma
21.*NameoftheBoard(ClassXII/Diploma)
22.* Whichtypeofschooldidyoustudyin? Chooseone 23.*
NameoftheCity/Town/VillageinwhichyourClassXIISchool/DiplomaInsttitutewas
Chooseone
http://www.faeaindia.org/NewApps/Fill_application.asp 2/2
locatedIfother,pleasespecify
24.* ClassXIIMediumofinstruction: Chooseone 25.*
ClassXII/DiplomaWasitaresidential(boarding)school
Chooseone
Ac a dem ic B a c k g ro und
26.* YearofpassingClassX Chooseyear 27.* ClassXpercentage %
28.* YearofpassingClassXIIExam/Diploma Chooseyear
29.*ClassXII/Diplomasubject
Choosesubject
30.* ClassXII/Diplomapercentage %
31.a* Proposedcourseofstudy Choosecourse
ifothers,pleasespecify:
31.b*
AreyoupresentlypursuinganyCourse(Graduation/Engineering/Diploma/PGEtc)?
Select
32.Whydoyouwanttojointhiscourse?(notmorethan200words)
(optional)Re fe re nc e D e t a i l s33.a Reference#1:Name
Gender Choosegender
Reference#1Address City/District
State/U.T. Select
PinCode
ContactNo./MobileNo.#1 ContactNo./MobileNo.#2 FaxNo.
EmailAddress
33.b Reference#2:Name Gender Choosegender
Reference#2Address City/District
State/U.T. Select
PinCode
ContactNo./MobileNo.#1 ContactNo./MobileNo.#2
FaxNo. EmailAddress
DeclarationIherebydeclarethatIhaveverifiedthedetailsindicatedaboveandIconfirmthatalltheinformationsubmitted
above is correct to the best of my knowledge. I will provide
documentary evidence in support of all the aboveinformation. If at
any stage, if it is found that any of the above information is
incorrect and/or is suppressed,
themanagementofFAEAshallhavetherighttotakepenalactionasdeemedfit.
ProceedNext... Reset
