GOVERNMENT OF ODISHA
DEPARTMENT OF HIGHER EDUCATION
***
 FORM FOR RENEWAL OF SCHOLARSHIP
(To be submitted by the student to the College Authority)
(As directed vide Office Order No. 1237 / HE. Dt. 01.05.2013)
Registration No.

PART - I  ( Scholarship and Institution Details )
(YEAR MEANS ACADEMIC SESSION)
Name of the scholarship
Name of course
Current year / semester of study
Duration  of course (In Year)
Wheather the student is pursuing B.Tech. course
Name and postal address of the educational Institution
E-mail address of the Institution
PART - II  (  Information of Scholarship Holder )
Name of the Student
Mobile phone number
Name of Father / Mother/ Guardian
Year of admission
Year in which application for award of scholarship was submitted
Year for which scholarship has been disbursed in the past
Class to which the student is promoted
Renewal of scholarship recommended for the year/s
PART - III  (  Bank Information of Scholarship Holder  )
Name of the Account holder
Saving Bank A/c. of student
IFSC number of the Bank
Address of the Bank
   
                        I have not availed any other scholarship except Medhabruti awarded by the Higher Education Department, Govt. of Odisha.
   
   
Signature of the student
PART - IV  (  Recommendation of the College Authority  )
                               Certified that the aforesaid information furnished by the student is correct and he / she is promoted to the next higher class..............................  It is therefore recommended that as the academic performance and conduct of the student is satisfactory, renewal scholarship for the year....................... may be granted in his / her favour in time. The concerned student is not availed any other scholarship awarded by the State / Central Government simultaneously during his period of study.
 
Place
Signature & Seal of
Head of the Institution /
Authorized Officer

Date