EAK Application Form 2022 - 2023


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Email *
Scholarship Year: 2022 - 2023
Date of Application *
MM
/
DD
/
YYYY
Application Type: *
Select Renewal option only if EAK scholarship was granted last year
Applicant's Personal Information
1) Name of the Applicant: *
Same as in Bank Account
2) Aadhaar Number: *
3) Home Address: *
4.a) Home Phone:
4.b) Mobile Phone
5) Any physical disability? *
Please attach a valid medical certificate if the answer is Yes
Education History
Enter % Marks or Grade. Indicate if rank holder, special awards
6.a) 10th or equivalent *
6.b) 12th or equivalent *
6.c) Bachelor / Professional Degree
Course Information
7.a) Professional Course *
Professional course for which you are applying this scholarship
7.b) Course Discipline
e.g. Nursing, Electrical Engg. etc..
8.a) Name of the College *
Name of educational institution where admission has been secured  
8.b) Address of the College *
9) Name, address, email and phone number of a faculty at this institution who may know you personally.  
a professor, principal, head of department or student counselor
10) Start date of the program *
If you do not know the exact day, select 1
MM
/
DD
/
YYYY
11) Total Course Duration *
12) Current Course Year *
13) Expected year of course completion *
14.a) Annual Tuition Fees (in INR) *
Attach supporting documents
14.b) Annual Hostel Fees (in INR)
Attach supporting documents
14.c) Annual Book Fees (in INR)
14.d) Annual Travel Expenses (in INR)
14.e) Other Expenses (Describe)
15.a) Is your education financed? *
15.b) Indicate approximate % of each source
e.g. Parental Support:_____%, Scholarship:_____%, Bank Loan:_____%, Other resources (specify): ______________________%
15.c) Name of the Financial Institution or the Bank funding your education
Family Information
16) Father's Name *
17) Mother's Name *
18) Father's Occupation *
If the applicant’s father is deceased, please indicate here
19) Mother's Occupation *
If the applicant’s mother is deceased, please indicate here
20) Names, Education status and details about siblings *
e.g: Jane Doe - Sister - Studying in 10th
21) Other family members in the same household *
indicate name, relationship and what they currently do
22) Annual Gross Income of the Family (in INR) *
23) Income Certificate from Village Office attached? *
EAK will not be able to process your application without the certification from Village Officer
Bank Information
EAK will send the scholarship amount to this bank account. Please attach a clear copy of the pass  book, cancelled cheque
24.a) Bank Account Number *
24.b) Bank Name *
24.c) Branch Name and Address *
24.d) Account Holder Name *
Account Holder should be same as Applicant
24.e) IFSC *
Advisor and Other Information
25) References *
Provide Name, Phone Number of two or three persons who are not related, but personally know you and your family. One contact should be from a well-known individual locally (e.g. College or School principal, Panchayath Member, Bank Manager)
26) Additional Comments
27) Please choose your Advisor below *
Advisor's Signature is required.  Please contact your advisor and have him/her sign in the space provided below
28) Advisor's Signature and Date *
Print and get Advisor's signature and date below
29) Supporting Documents
Please email scanned copies of the following documents with the signed application to contact@educateakid.org
30) Declaration:   I hereby certify that above information is true to the best of my knowledge.  I hereby promise that I will promote EducateAKid mission and help other needy students after I gain employment.
Applicant's signature and date on the hard copy
A copy of your responses will be emailed to the address you provided.
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