GGGS NOMINATION FORM (08-02-14)
Saroda, Dholka Taluka,
Ahmedabad - 382260, Gujarat, India
Dr. Şebnem K. Akçapar Un iversity Scholarship
FOR UNDERPRIVILEGED GIRL TOTALLY FREE OF COST INCLUDING BOARDING & LODGING
Details of the nominee:
Name of the Nominee
Date of Birth
Name of the Father/Guardian
Occupation and Monthly Income
Name of the Mother
Occupation and Monthly Income
City & Country
(Ph) Landline (R) :
Email (if any) :
Education Qualification (Class Xth onwards)
Certificate / Degree
Year of Passing
University / Board
% of Marks
Write about your extracurricular activities and accomplishments. (Pls. attach separate sheets, if required)
10. Give us a glimpse of some situations pertaining to your High School, Family or Community that will give us a better understanding about
you and your aspirations. (Pls. attach separate sheets, if required)
11. How was your earlier education? What skills did you learnt and what was missing? (Pls. attach separate sheets, if required)
12. How have your brothers/sisters and parents impacted your thoughts? Give us some details about them.(Pls. attach separate sheets, if required)
13. What community work and social contributions have you made during your school/college holidays? (Pls. attach separate sheets, if required)
14. Have you had access to computers and internet? If yes, what have you learned? (Pls. attach separate sheets, if required)
15. Give examples where you have demonstrated qualities of leadership, social caring, innovation and determination. (Pls. attach separate
sheets, if required)
Please write on a separate sheet of paper an essay (400 words). —
16. What do you aspire to be and how this scholarship will help you realise your dreams and achieve your goals?
17. Tick (
) the higher education option of your choices. Please visit our website www.dreamzrf.org for more course options & details:
Bachelors in Business Management- BBA (Duration - 3 Years)
q BSc. Media & Communication (Duration - 3 Years)
BSc. Hospitality Management (Duration - 3 Years)
q BA Fashion Technology (Duration - 3 Years)
B.Tech - Biotech., Elect. & Comm., Computer Science, Mech. Engg. (Duration - 4 Years)
Masters in Business Management -MBA (Duration - 2 Years)
q Other course as on website (specify)__________________________
18. Give reasons for choosing the course you have chosen. How will you use this knowledge to serve the society?
19a Tick ( ) the appropriate details:
Single Parent q
No. of Sisters______
No. of Brothers______
20. Are you the 1st member of the family/community applying for higher education? Yes/No __________.
ENTRY & ELIGIBILITY CRITERIA:
For Under Graduate degree programmes - 10+2 from a recognised board
For Post Graduate degree programme - Graduation from recognised University
B.Tech Electronic and Communication - 10+2 (PCM)
B.Tech Biotechnology - 10+2 (PCB)
Basic English writing and speaking skills
This scholarship covers the full tuition fee including boarding & lodging for the entire duration of the programme (3years / 4 years as applied).
Transport to & from the campus during admissions & vacations is the responsibility of the parents/students. Students can stay during Summer/Winter
holidays at campus.
Passport/Visa processing fees, visa extension fees, minor medical expenses which are not covered under the cashless medical facility and other out of
pocket expenses for basic personal requirements are to be borne by the student/parents/sponsors themselves.
Academic session for 2015 batch will commence from 1st August, 2015. New students will undergo an orientation program for one week.
In case it is found at any stage that any incorrect information has been given or some material facts have been concealed, the student is liable to eviction
from the University. Besides such other action that the University deems fit may be initiated against her. The University will not be responsible for
student's loss of studies .
Fully filled up form duly completed in all respects should reach the Foundation by 15th May, 2015. All the information is mandatory. Half filled
nomination forms will not be accepted..
I, hereby, declare that all the information provided by me is true and correct to the best of our knowledge.
Signature of the Nominee
Signature of Parent
I, Dr. Şebnem K. Akçapar nominate her for the scholarship in my name.
Evidence of the date of birth.
Income Certificate of Parents (original).
Fitness (Medical certificate ) from a qualified Doctor.
Legal proof of Income of Parents (attested photocopy)
Ten (10) number of coloured passport size photographs.
Attested photocopies of Mark Sheet (Class Xth onwards).
Attested copy of the Graduation Degree or Provisional Certificate.
Character certificate from the Principal of the school/college last attended.
Medical & other case history duly signed by the Head / Trustee of the NGO / Orphanage
Attested copy of the statement of marks and pass certificates (10th, 12th, Graduation) of the qualifying examinations.
Rules and Regulations
Students should maintain 75% attendance in classes.
Change of course will not be entertained after the admission.
All campus rules and regulation as mentioned in student handbook are to be followed strictly.
Students failing in exams will have to repeat that paper at their own cost as per university norms.
Any student found violating the campus and hostel rules will be asked to discontinue the studies and will have to leave.
Any drop-out after the commencement of the academic session, would require to submit the fees of that particular semester and medical insurance
premiums of that particular year.
7. The scholarship in subsequent semester will be subject to the candidates acquiring and maintaining minimum 60% marks in aggregate as well as
displaying her good conduct at the university.
For queries, contact:
Ms. Babita Pandita
Scholarship Program Head
Mobile: +918860100258 | Email: [email protected]