APPLICATION DR. NIDHI KADIR WATSON MEMORIAL SCHOLARSHIP

(Awarded by NKW Program, Houston, Texas, USA)
(See “Information for Applicants” for details and instructions.)

Read the following before start filling the APPLICATION:

• Provide complete answer to all questions. No columns should leave blank.
• Scholarship is for applicant joined the institution (first year) in the current academic year. Applications from applicants of previous years (2^nd, 3^rd and 4^th) will not be considered.
• Provide self assessed total income against “Total Family Income”. Do not provide the figure as indicated in the Income Certificate issued by Panchayat, Municipality or Corporation
• Applications from applicants who have completed diploma course and joined for engineering degree course thereafter will not be considered.
• Last date for submission of application is December 31of this year for Engineering and Medicine. Result will be published before January 31 of next year.

Apply Application Online

Name of Applicant:

Date of Birth:

Home Address:

Telephone Applicant:

Telephone Parents:

Applicant Email Address:

Institution Telephone:

Institution Address Currently Enrolled: (include email address)

Academic Data (Certified copies of mark sheets and / or rank certificate to be submitted on request only from the selected applicant as stated in the “Information For Applicants” chapter. Do not attach any of the documents along with application)

Name of Institution	Date Passed	% Marks/Rank
School: SSLC / CBSE / ICSE
Plus-2:

Entrance Examination Rank (list separately such as All India, OBC, Kerala, CUSAT). Applicant should list ranks of all entrance examinations he/she participated.

MEDICINE:

All India ( NEET ):

OBC:

Kerala ( KEAM ):

OBC:

ENGINEERING:

All India ( JEE ):

OBC:

Kerala ( KEAM ):

OBC:

CUSAT:

Did you take Coaching Classes for Entrance Exam?:

Yes

No

No. of attempts at Entrance Exam:

Institution where you had coaching for Entrance Examination:

Duration of coaching class:

Fees paid for Entrance exam coaching Class:

Father’s Name:	Mother's Name:
Education Qualification:	Education Qualification:
Occupation:	Occupation:
Employer:	Employer:

If parent is involved in agriculture, business, employed or daily wage/ labour, please provide a statement below explaining in detail the type of agriculture, business, employment, work or labour so that Program can evaluate candidate’s financial condition. :

Did your parents (father/mother or both) work abroad?

Yes

No

If yes, Provide the name of country worked :

The period (from which year to which year):

1) Father’s Income per year:

2) Mother’s Income per year:

3) Income from other sources per year:

Self Assessed “Total Family Income” per year (1+2+3):

Does your family own any four-wheel vehicles (i.e. car, van, truck, etc.)?

Yes

No

If Yes, how many?

Estimated value of the vehicles: Rs.:

Does your family own the house you live in? Yes or No

Yes

No

If Yes, how many cents of land and what is the current market value for the property and house?

Cents of Land:

Current Market Value:

It you live in a rented house, what is the monthly rent?

Do your parents own any land, house or other real estate property other than the house you live?

Yes

No

If Yes, how much land does your family own? ( acres/cents)

What is the total value of the above property (based on current market value)? Rs.:

Did you apply for any other scholarship or financial assistance such as e-grant, McM, MEA-USA etc.?

Yes

No

If Yes, from which organization?

Amount of scholarship per year :

Duration of scholarship in years

Do you currently receive any scholarship or financial assistance?

Yes

No

If Yes, from which organization and contact phone no. of the responsible person?

Amount of scholarship per year:

Duration of scholarship in years

Did you take any educational loan on repayable basis with interest from any Bank or Financial Institution?

Yes

No

If Yes, from which organization and contact phone no. of the responsible person?

Amount of loan taken?

How many brothers and sisters do you have?

Name of brothers and sisters	Age	Education Status	If employed, yearly income	Marital Status including number of kids

College/tuition fees you need to pay- per year:

Any other fees other than tuition fee to be paid per year or one time payment (state clearly):

During your course of study, are you going to stay in hostel or home?

Hostel/boarding fees you need to pay if you opt to stay in hostel- per year:

Books/Clothes/Other incidental Expenses-per year:

Name of College you are currently enrolled in:

Name Of University:

Date Of Joining the College:

Extra-curricular activities and Extra ordinary Circumstances:

If the applicant has won significant awards or prizes or represented School or College in athletics, sports, fine arts or other extra-curricular activities, please state below the details of such awards and activities.

If the applicant feel that he or she faces an extra ordinary circumstances as stated in the “Information For Applicants” shall be stated below:

I solemnly swear that the information furnished by me in this application is completely true and correct. I understand that falsification of information will result in immediate termination of scholarship and require refund of all amounts received including legal action.

Date of Submission:

Enter the numbers as shown in the image

Submit