Application Form for Assistance - Academic Year: 2016-17

Name of the Student*:   Faculty:
D-O-B:    Age: Department:
Sex: Course:
Mobile: Duration:
Email ID: Year:
JU ID: Father's Name:
Roll No: Father's Occupation:
Handicap (%, if Yes): Father's Income (Rs./Yr.):
Food Habit: Mother's Name:
Std. Status Mother's Occupation:
HS/Eqv. % or Grade   Mother's Income (Rs./Yr.):
Last Sem % or Grade Guardian's Name (if father deceased):
Present Address: Permanent Address:
( same as present address)

PIN PIN
Residence Type: Residence Type:
Whether Applicant does any work for self-support: No of Family members:
  Total Family Income (Rs./Yr.):
Financial Assistance received:
(in past years)
Financial Assistance applied for:
Savings A/C no:
(SBI or Canara bank only)
Branch Name:
Joined NSS:
I declare that all information provided above are correct. I understand that any information provided if found to be incorrect, this application would be liable for rejection and matter may be reported to JU authorities. Also incomplete applications would be liable for rejection without any further reference. I also agree to abide by the instructions and guidelines from the Alumni Association to be eligible for the continuance of the assistance, if awarded.