हिमाचल प्रदेश केंद्रीय विश्िविद्यालय
Central University of Himachal Pradesh
(Established Under Central Universities Act 2009)
Application Format for Free-ship for the Academic Session....................

Name of the Applicant
(in Capital Letters) ……………………………………………………………
Roll No………………………
PHOTOGRAPH
Programme of Studies …………………....
Semester………………
Year of Admission………………
School…………………………………………………………….
Dept./Centre……………………………………….
Date of Birth ……………………………………
Nationality …………….
Category …………………………… BANK DETAILS (Mandatory)
Saving Bank Account No. of Applicant:
Name & Address of Bank:
IFSC Code of Branch :
Contact / Mobile No. :
ACADEMIC PERFORMANCE
In case of 1st Semester Students
In case of 3rd Semester Students
Sr. No.
Class
Year
Percentage %
1. 10th
2. 10+2
3. UG

Sr. No.
Semester
Year
Percentage %
Grade
% of Attendance
1. 1st Semester
2. 2nd Semester
3. Cumulative Grade
FAMILY DETAILS
Name
Occupation
Annual Income (Rs.)
Father
Mother
Spouse
Guardian
PARTICULARS OF FAMILY INCOME
A. Annual Income of the Family: _________________________________________
B. Are you receiving any other scholarship/financial assistance: Yes/No ___________________
(If Yes, give the details ________________________________________________________________)
Permanent Address of the Parent/Guardian.............................................................................................................
........................................................................ Pin Code.......................... Mobile No. ................................................
I hereby undertake that all the information furnished as above are true and correct.
Dated: ..................... Signature of the Student...........................Signature of the Parents/Guardian........................................
Comments/Observation of the Head of the Department/Director of the Centre
Attendance (% age) ................................................ Conduct & Discipline............................................... Punctuality & Regularity: ........................................ Recommendation: .......................................................
Signature of the Head of the Department/Director of the Centre
Decision of the Free-ship Committee
1. Recommended for the award of.................... (Full Free-ship / Half-Free-ship) with condition that the student has to observe discipline, punctuality and good conduct.
2. Not Recommended, reasons, thereof .......................................................................
Dean of the School