TO BE FILLED IN BY MISSION AND ATTACHED TO EACH COPY OF APPLICATION ICCR SCHOLARSHIP APPLICATIONS CHECK LIST FOR MISSIONS 1. Application form being used is for the right academic year. ( ) 2. Five copies/ sets of the application duly filled in and properly tagged are sent herewith ( ) 3. Scholarship scheme has been selected/ ticked properly by the scholar ( ) 4. Course/ University option has been properly indicated by the scholar ( ) 5. There are six recent passport size photographs, five pasted (one on each form with signature) and one additional photograph not pasted to any form ( ) 6. Certified copies have been attached of the syllabi and graduation certificates/ marksheets for all educational qualification listed ( ) 7. Marksheets etc. for the minimum qualifications required by the student to qualify for his course of choice have been attached ( ) 8. Synopsis of proposed area of research have been attached by the student who is applying for doctoral/ post doctoral course ( ) 9. This application is for a B.E. course and has the confirmation the candidate has taken Physics, Chemistry and Mathematics (PCM) in his/her school leaving examinations (mandatory requirement) for Engineering courses ( ) 10. Video/ audio cassettes of students wishing to study performing Arts are enclosed. ( ) 11. Certified copies of translations of documents which are not in English are attached ( ) 12. Certified that no original documents attached with this application ( ) 13. Certificate of Physical fitness is attached ( ) 14. Character recommendations are attached ( ) 15. Certificate by Mission including certification of student’s English skills are attached ( ) 16. Certified copies of relevant pages of passport are attached ( ) 17. Undertaking has been given by student that he will abide by terms and conditions of ICCR scholarships ( ) 18. Certified that student has not been given ICCR scholarship before (Note: If s/he has already availed of an ICCR scholarship, please attach HOM’s recommendation as to why s/he should be given scholarship for the second time) ( ) 19. Certified that student is not already studying in India (Note: If student is already studying in India, please attach HOM’s recommendation as to why s/he should be converted into an ICCR scholar) ( ) 20. Certified that application form is complete in every respect ( ) Signature___________________ Name______________________ Designation_________________ Mission____________________ CERTIFICATE TO BE FURNISHED BY THE INDIAN DIPLOMATIC REPRESENTATIVE Certified that I am satisfied that Mr./Mrs./Miss _____________________________________________________________________ (Name of candidate) is permanently domiciled in _____________________________________________________________________ (Name of country) and on completion of his / her studies in India will return to _____________________________________________________________________ (Name of the country of domicile) Certified that all entries in the application form have been checked with the original documents and that the application is complete in all respects. Attested copies of certificates, diplomas or degrees of examination passed are enclosed. Certified that the candidate’s knowledge of English is sufficient to enable him/her to follow lectures and instructions given in English and to take examinations in that language. Date ____________________ Signature ______________________ Place ___________________ Designation _____________________ INDIAN COUNCIL FOR CULTURAL RELATIONS APPLICATION FORM FOR ICCR SCHOLARSHIPS FOR FOREIGN NATIONALS FOR THE ACADEMIC YEAR 2014-15 Please tick Scholarship Scheme for which application is being made: ( ) General Scholarship Scheme (GSS; formerly known as General Cultural Scholarship Scheme or GCSS) ( ) Scholarships under bilateral Cultural Exchange Programmes (CEP Scholarship) ( ) Scholarships for students from Commonwealth Countries (ICCR’s Commonwealth Scholarship Plan) ( ) Scholarships for students from African Countries ( ) Scholarships for students from SAARC Countries ( ) Scholarships for students from Mekong Ganga Co-operation (MGC) Countries ( ) AYUSH Scholarships to study Indian Traditional Medicine Systems such as Ayurveda, Unani, Siddha & Homeopathy (available for students from all Countries, though priority is given to those from BIMSTEC Countries) ( ) AYUSH Scholarships to study Indian Traditional Medicine Systems such as Ayurveda, Unani, Siddha & Homeopathy for Malaysian nationals ( ) Scholarships for Afghan nationals Scholarships for Sri Lankan nationals ( ) Nehru Memorial Scholarship Scheme ( ) Maulana Azad Scholarship Scheme ( ) Rajiv Gandhi Scholarship Scheme ( ) Scholarships for Bangladeshi nationals ( ) Scholarships for Nepalese nationals (also known as Silver Jubilee Scholarship Scheme) ( ) Scholarships for Mongolian nationals ( ) Scholarships for Bhutanese nationals ( ) ( ) Scholarships for Maldivian nationals ICCR Cultural Scholarship Scheme (For Dance/Music/Yoga/Art) For further specifications of each Scheme, may refer to ICCR Website Please tick one of the following course options: ( ) UG ( ) PG ( ) Ph.D ( ) Ayush _______________________________________________________________________ AZAD BHAVAN, INDRAPRASTHA ESTATE, NEW DELHI-110002 Website: iccrindia.net INSTRUCTIONS TO CANDIDATES FOR FILLING THE APPLICATION FORM 1 All entries (except the signature) in the application should, be typewritten or handwritten in block letters (capitals). 2 Six copies of application, duly filled and properly tagged, are to be submitted. 3 Each copy should be complete in all respects, with all the required information and all necessary supporting documents, as listed below: i. A recent passport size photograph (taken not earlier than a year before the date of the application) should be pasted on the application form in the space provided for the purpose. The name should be written on the photograph for purpose of identification. ii. Apart from these six photographs which are to be pasted on the applications, one additional photograph, not pasted to any form, must be supplied. iii. Certified copy of the syllabi, curricula, etc. of courses covered in schools, colleges, universities attended (except the Senior Cambridge, High Cambridge and London General Certificate of Education examination) with full details. Note: If this information is not supplied, your application will not be considered, as this information is required in order to establish equivalency with Indian academic standards. iv. Certified photostat copies of all academic qualifications certificates and marksheets, including those relating to school leaving examination, which are mandatory for the course for which you have applied. Note: Please ensure that certified copies of documents showing specific qualifications required for the course of your choice (such as GMAT scores for admission in MBA/TOEFL/IELTS scores for English courses etc.) are also attached. The requirements can be checked from the UGC website / Handbook or from the website of the institution concerned. v. A certificate of physical fitness in the prescribed form. vi. Recommendations / character certificates as required under S. No.15 of this form. vii. Certified copies of relevant pages of candidate’s valid passport (max validity), showing photograph, name, contact details, date of issue, date of expiry and place of issue. (Note: Please ensure that your passport is valid for the duration of the course for which you have applied.) (ORIGINAL DOCUMENTS SHOULD NOT BE SENT WITH THE APPLICATION AS THESE WILL NOT BE RETURNED TO THE APPLICANT.) APPLICATION FORM 1. Full name (IN BLOCK LETTERS) (Mr. / Mrs. / Miss) Mr. Rupan Chakma 2. Male (male ) Female ( ) 3. Contact details:- i. Tel: ii. Fax: iii. Email: iv. Postal address: 4. Permanent home address (IN BLOCK LETTERS) T.N.T, Rangamati,Chittagong, Bangladesh 5. Date of birth: 26/02/1993 Nationality: Bangladesh 6. Country of residence :Dhaka 7. Passport No. _______________________________________ i. Date of issue _______________________ ii. Date of expiry ________________________ iii. Place of issue ____________________________________ 8. Details of Father / Guardian Name:Kornabir Chakma Relation (F/G): Buddish Occupation: Business Nationality:Bangladesh Address of permanent: vill: Ultachari. Post office : Longadu District: Rangamati , Country: Bangladesh residence of Father / Guardian: Ultachari 9. Knowledge of proficiency in English Written Good ( ) Fair ( ) Poor ( ) Spoken Good ( ) Fair ( ) Poor ( ) Specify level of examination passed in English and grades obtained. 10. Knowledge of any other language __________________________________________ Written Good ( ) Fair ( ) Poor ( ) Spoken Good ( ) Fair ( ) Poor ( ) Understand Good ( ) Fair ( ) Poor ( ) 11. Give details, if any (a) Proficiency acquired in games, sports & athletics; and (b) Part taken in other extra-curricular or social activities 12. State in order of preference the Universities / Institutes in India in which you seek admission: 1. 2. 3. NOTE: Please refer to “Universities Handbook of India” available with the Indian Diplomatic Mission in your country or go to University Grants Commission (UGC) website at ugc.ac.in Please note that ICCR provides scholarships only for courses in central or state government universities as listed by the UGC, and for courses in deemed universities which have been approved by UGC. There is no guarantee of admission in your choice of University / Institution. In case of non-availability of a particular course in a particular Institution, the Council will forward the application to other Universities/Institutions where such courses are available. The Council would try to accommodate the candidates as per their choice of course/institute. However, the Council reserves the right to offer admissions for any course or institution in India even if these are not among the candidate’s preferred choice. While the candidate may decide whether or no to accept such an offer, it may be noted that once accepted, no change in either course or University will be permitted. 13. State in order of preference the courses which you would like to study in India. 1. 2. 3. NOTE: Candidate should be very specific and clear about the course of study, which he / she wishes to pursue in India. Scholarships are not available to pursue more than one course. Candidate should ensure that the courses listed here are offered by all three of the Universities listed under S.No.12 above. The candidates must refer to the Universities/Institute Website to know the eligibility criteria for the courses of their choice. 14. PREVIOUS EDUCATIONAL QUALIFICATIONS (Fill in all columns which are applicable to you): Certificate / Degree Country Name of School/ University / Board Year of Graduation Percentage Secondary School Certificate(SSC) Bangladesh Rabeta Model High School, Board: Chittagong 2 0 1 0 4 3 8 Undergraduate (equivalent to three years course after grade XII in India) Post graduate (Two years’ Masters’ course after the above mentioned undergraduate or five years’ Masters’ course after grade XII) DOCTORAL (Ph.D) (After Masters’ Degree) Accepted OR Not yet accepted Note: Details of any course in Indian Universities / Institutes which the scholar is currently attending or has attended in past may be given below. Year Name of University / Institute Course 15. Give below the names of two persons who have agreed to testify from their personal knowledge to your character (they must not be related to you and should have direct knowledge of your academic pursuits and attach recommendation letters / character certificates signed by them). (a) Name ________________________________________________ Status/ Designation ________________________________________________ Address ________________________________________________ E-mail ________________________________________________ (b) Name ________________________________________________ Status/ Designation ________________________________________________ Address ________________________________________________ E-mail ________________________________________________ 16. Details of close relative (s) or friends, if any, in India. I. Name ________________________________________________ II. Relationship ________________________________________________ III. Status/ Designation ________________________________________________ IV. Address ________________________________________________ V. Tel No. ________________________________________________ VI. E-mail ________________________________________________ 17. Have you travelled or lived in India in the past. If so, mention places visited and dates of such visits. 18. Have you ever availed of ICCR Scholarship earlier? If so, please give full details. (i) Year of Scholarship (ii) Name of Course (iii) Name of the Institute / University (iv) Total duration of stay in India on scholarship 19. Any general remarks which you would like to offer (if the space is not sufficient, attach a separate sheet and sign the same). Date Place Signature of Applicant I hereby declare that the particulars given above are true to the best of my knowledge and belief, that I have understood the terms and conditions of the Scholarship Scheme as given above and in Annexures II and III and hereby undertake to abide by them, and that I also undertake to return to my country after completion of my studies in India. Signature of Applicant
Posted on: Sun, 21 Sep 2014 11:36:11 +0000
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