Scholarship

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Can & Will eduCATe Scholarship Form

Name :*

Qualification/Class :*

Institute :*

Passport Size photograph :*

Family Photograph of the Applicant :*

Application no :

CW-8818

Board/Exam :*

Rank/Score :*

DOB :*

Select Category :*

A. Academic Record*(One Record is required.)

S.No	Class/Semester	Academic Year	Institution	Board/Authority	Percentage
1.(R)
2.

B. Extra-Curricular/Sports/Hobbies Pursued

S.No	Activity	Academic Year	Level of Participation	Prizes Won (If any)
1.
2.
3.
4.

C. Awards & Scholarships

S.No	Name of Award/Scholarship	Year Awarded	Amount/Level	Awarding Body
1.
2.

D. Family BackGround

Relation	Name	Age + Academic Qualification	Occupation	Name of Employer	Monthly Income
Father*
Mother*




Others
TOTAL Family Income

E. Expenses Expected*(All Fields are required.)

Admission Fee*	Monthly Fee*	Books*	Stationery*	Uniform*

Tution Fee*	Hostel Fee*	Exam Fee*	Others (Specify)*	Total

			Specify Reason

F. Contact Details

	Present Address	Permanent Address
Address Line 1*
Address Line 2
District + State + PIN Code*
E-Mail Id*
Phone Number*

G. Reference (HOD / Teacher / C&W Member / Other)

	Reference 1 (Mandatory)*	Reference 2 (Desired)
Name*
Occupation*
Relationship with Applicant*
Number, Street*
City*
District + State + PIN Code*
E-Mail Id*
Contact Number*

Letter of Reference :*

H. Social Involvement

Have you been involved in any work/activity/program to change/improve your society/community?
If yes, describe the activity, it's impact on the society and what did you learn from it in 200 words?

I. Leadership

Can you share in 300 words an incident where you had to demonstrate leadership skills while at school/college/home or in your community?

J. Career Decisions

Can you tell us in 200 words the course/subjects you have chosen and how will they help you in your career?

K. Challenges

In 200 words, explain the challenges that you face in completing your studies and how can this scholarship benefit you? (after completing your studies)

Terms and conditions

Declaration*

I agree with all the terms and conditions. Details submitted and documents provided along with this application, are correct and true. I accept that my details may be published by Can & Will Foundation, as part of case studies, as and well needed.

Proof Attached herewith

Birth Certificate Last Year's Report Card This Year's Running Report Card
Parent/Guardian's BPL Card Voters Card / Letter from Sarpanch-Councillor Income Proof Last 6 Months Bank Statement

Upload documents :*

APPLICANT SIGNATURE

Name :*

Date :*

Place :*

APPLICANT'S PARENT/GUARDIAN's SIGNATURE

Name :*

Date :*

Place :*

To be filled by Canandwill foundation (Not to be filled by Applicant)

Recommending Member:

Amount Approved by C&W Rs :

Reason for recommendation/deferral: